Effects of orientation and distance of goats on blast lung injury characteristics on a plateau above 4500-meter / 中华创伤杂志(英文版)

PURPOSE@#High explosives are used to produce blast waves to study their biological effects. The lungs are considered as the critical target organ in blast-effect studies. The degree of lung hemorrhaging is related to both the explosive power and the increased lung weight. We studied the characteristics of the biological effects from an air explosion of a thermobaric bomb in a high-altitude environment and the lethality and lung injury severity of goats in different orientations and distances.@*METHODS@#Goats were placed at 2.5, 3, 4, and 5 m from the explosion center and exposed them to an air blast at an altitude of 4700-meter. A group of them standing oriented to the right side and the other group seated facing the explosion center vertically. The lung injuries were quantified according to the percentage of surface area contused, and using the pathologic severity scale of lung blast injury (PSSLBI) to score the 4 injury categories (slight, moderate, serious and severe) as 1, 2, 3, and 4, respectively. The lung coefficient (lung weight [g]/body weight [kg]) was the indicator of pulmonary edema and was related to lung injury severity. Blast overpressure data were collected using blast test devices placed at matching locations to represent loadings to goats. All statistical analyses were performed using SPSS, version 26.0, statistical software (SPSS, Inc., Chicago, IL, USA).@*RESULTS@#In total, 127 goats were involved in this study. Right-side-standing goats had a significantly higher mortality rate than those seated vertical-facing (p < 0.05). At the 2.5 m distance, the goat mortality was nearly 100%, whereas at 5 m, all the goats survived. Lung injuries of the right-side-standing goats were 1 - 2 grades more serious than those of seated goats at the same distances, the scores of PSSLBI were significantly higher than the seated vertical-facing goats (p < 0.05). The lung coefficient of the right-side-standing goats were significantly higher than those of seated vertical-facing (p < 0.05). Mortality, PSSLBI, and the lung coefficient results indicated that the right-side-standing goats experienced severer injuries than the seated vertical-facing goats, and the injuries were lessened as the distance increased. The blast overpressure was consistent with these results.@*CONCLUSION@#The main killing factors of the thermobaric bomb in the high-altitude environment were blast overpressure, blast wind propulsions and burn. The orientation and distances of the goats significantly affected the blast injury severity. These results may provide a research basis for diagnosing, treating and protecting against injuries from thermobaric explosions.

Intoxicación cronica por metales tóxicos en supervivientes de artefactos explosivos improvisados con fragmentos incorporados y su potencial neoplásico. Revisión sistemática exploratoria / Chronic heavy metal intoxication in survivors of improvised explosive devices with embedded fragments and its neoplastic potential. Exploratory systematic review

Resumen Introducción: Los artefactos explosivos improvisados son armas no convencionales que pueden provocar múltiples lesiones y dejar esquirlas a modo de cuerpos extraños que pueden contener metales tóxicos, con potencial afectación a la salud de las víctimas según reportes datados desde 1977, los cuales mencionan alta mortalidad por cáncer y otros síntomas compatibles con toxicidad crónica Objetivo: Describir los resultados de investigación que informen sobre la toxicidad crónica producida por metales en personas víctimas de artefactos explosivos improvisados con esquirlas internalizadas, y sus posibles relaciones con cáncer. Metodología: Revisión sistemática exploratoria de literatura publicada y gris que se realizó entre los meses de marzo a mayo de 2021 en diferentes repositorios de tesis y bases de datos (Scielo, Pubmed, Academic Search Complete, JSTOR, Biblioteca Virtual en Salud, Freepdf, Google Académico, Open Grey); sin límite temporal o geográfico. Se incluyeron artículos originales de revistas indexadas o informes finales no publicados, correspondientes a investigaciones científicas con texto completo, en inglés, español y portugués. Resultados: De 56 documentos evaluados, solamente tres cumplieron criterios de inclusión. Todos estaban escritos en idioma inglés. Solo un estudio iraquí abordó población civil y los otros trabajos aludían a veteranos norteamericanos. Los niveles elevados de metales tóxicos, asociados con alteraciones tisulares circunscritas, fueron hallazgos recurrentes. No hubo reportes de patologías instauradas o manejos clínicos. Conclusión: Fue escasa la evidencia científica recabada; sin embargo, sí se han reportado cambios tisulares circundantes a esas esquirlas. Se considera necesario realizar más estudios relacionados con el tema, incluyendo seguimientos a largo plazo de las afectaciones tisulares detectadas.

Abstract Introduction: Improvised explosive devices are unconventionalweapons that can cause multiple injuries and splinters internalized containing heavy metals, potentially affecting the victim's health, according to reports dating from 1977, which mention high mortality from cancer and other symptoms suggestive of chronic metal toxicity. Objective: To describe the research results that report on the chronic toxicity produced by heavy metals in people who are victims of improvised explosive devices with internalized splinters, and its possible links with cancer. Methodology: Systematic exploratory review of published and grey literature which was carried out between march and may of 2021, in thesis repositories and different databases (Scielo, Pubmed, Academic Search Complete, JSTOR, Biblioteca Virtual en Salud, Freepdf, Google Académico, Open Grey); without time or geographical limit. Original articles from indexed scientific research journals or unpublished final reports were included, corresponding to scientific research with full text, in english, spanish and portuguese. Results: 56 documents were evaluated, three were selected fulfilling the inclusion criteria. They were all written in the english language. Only one Iraqi study addressed the civilian population and the other studies referred to North American veterans. Elevated heavy metal levels, associated with circumscribed tissue abnormalities, were recurrent findings. There were no reports of established pathologies or clinical management. Conclusion: The scientific evidence was scarce; as well as its relationship with established cancer, however, tissue changing surrounding these splinters have been reported. It is considered necessary to carry out more studies related to the subject, including long-term follow-up of detected tissue damage.

Disparidades por etnia en la mortalidad por minas antipersona: un análisis a nivel país / Ethnic disparities in mortality from landmines: A country-level analysis

Resumen Introducción. El Registro Colombiano de Víctimas de Lesiones por Minas Antipersona fue lanzado por el gobierno de Colombia con el objetivo de recolectar información sobre los casos de heridos por minas antipersona en el país. El propósito de este estudio fue investigar las disparidades de mortalidad entre las víctimas de lesiones por minas antipersona, en función de la pertenencia a una minoría étnica. Métodos. Se hizo una regresión logística multivariable para examinar la asociación entre minorías étnicas y mortalidad en las personas heridas por minas antipersona. Resultados. Se registraron 10.306 casos de lesiones por minas antipersona, de los cuales 430 eran personas pertenecientes a grupos étnicos minoritarios (indígenas o afrodescendientes). De estos, 85 (19,7 %) eran mujeres, 156 (36,2 %) eran menores de 18 años y 427 (99,3%) vivían en áreas rurales. La mortalidad fue significativamente mayor (29,3 %) en comparación con la población mestiza (18,5 %; p < 0,001). Después de ajustar por sexo, edad, soldado en servicio activo, área rural y volumen de casos por departamento, encontramos que las minorías étnicas tenían mayores probabilidades de morir (OR = 2,03; IC95% 1,61- 2,56; p < 0,001). Discusión. Encontramos una asociación entre la pertenencia a una minoría étnica y una mayor probabilidad de mortalidad con lesiones causadas por minas antipersona. Estos hallazgos deberían alentar a los legisladores de las zonas rurales de Colombia a trabajar más diligentemente, para reducir las consecuencias nocivas de las lesiones causadas por estos artefactos en los grupos étnicos minoritarios.

Abstract Introduction. The Colombian Victims of Antipersonnel Mines Injuries registry was launched by the Colombian government with the objective of collecting information on all the cases of injuries caused by antipersonnel landmines in the country. The purpose of this study was to investigate the mortality disparities among ethnic minority victims of antipersonnel landmine injuries. Methods. A multivariate logistic regression was performed to examine the association between ethnic minorities and mortality in people injured by antipersonnel mines. Results. A total of 10,306 cases of injuries caused by antipersonnel landmines were registered, of which 430 were people belonging to minority ethnic groups (indigenous or Afro-descendant). Of these, 85 (19.7%) were women and 156 (36.2%) were under 18 years of age. Almost all people from ethnic minority groups were located in rural areas (n=427, 99.3%) and mortality was significantly higher compared to the mestizo population (mestizo 18.5% vs. individuals from ethnic minorities 29, 3%; p <0.001). After adjusting for sex, age group, active duty soldier status, rural area, and case volume for each geographic department, we found that ethnic minorities were more likely to die after suffering an antipersonnel mine injury (OR = 2.03; 95% CI 1.61-2.56; p <0.001). Discussion. We found an association between belonging to an ethnic minority and a higher probability of mortality with injuries caused by antipersonnel mines. These findings should encourage legislators in rural Colombia to work more diligently to reduce the harmful consequences of injuries caused by these devices in ethnic minority groups.

Ethnic disparities in mortality from landmines: A country-level analysis / Ethnic disparities in mortality from landmines: A country-level analysis

Introducción. El Registro Colombiano de Víctimas de Lesiones por Minas Antipersona fue lanzado por el gobierno de Colombia con el objetivo de recolectar información sobre los casos de heridos por minas antipersona en el país. El propósito de este estudio fue investigar las disparidades de mortalidad entre las víctimas de lesiones por minas antipersona, en función de la pertenencia a una minoría étnica. Métodos. Se hizo una regresión logística multivariable para examinar la asociación entre minorías étnicas y mortalidad en las personas heridas por minas antipersona. Resultados. Se registraron 10.306 casos de lesiones por minas antipersona, de los cuales 430 eran personas pertenecientes a grupos étnicos minoritarios (indígenas o afrodescendientes). De estos, 85 (19,7 %) eran mujeres, 156 (36,2 %) eran menores de 18 años y 427 (99,3%) vivían en áreas rurales. La mortalidad fue significativamente mayor (29,3 %) en comparación con la población mestiza (18,5 %; p < 0,001). Después de ajustar por sexo, edad, soldado en servicio activo, área rural y volumen de casos por departamento, encontramos que las minorías étnicas tenían mayores probabilidades de morir (OR = 2,03; IC95% 1,61- 2,56; p < 0,001).Discusión. Encontramos una asociación entre la pertenencia a una minoría étnica y una mayor probabilidad de mortalidad con lesiones causadas por minas antipersona. Estos hallazgos deberían alentar a los legisladores de las zonas rurales de Colombia a trabajar más diligentemente, para reducir las consecuencias nocivas de las lesiones causadas por estos artefactos en los grupos étnicos minoritarios

Introduction. The Colombian Victims of Antipersonnel Mines Injuries registry was launched by the Colombian government with the objective of collecting information on all the cases of injuries caused by antipersonnel landmines in the country. The purpose of this study was to investigate the mortality disparities among ethnic minority victims of antipersonnel landmine injuries.Methods. A multivariate logistic regression was performed to examine the association between ethnic minorities and mortality in people injured by antipersonnel mines. Results. A total of 10,306 cases of injuries caused by antipersonnel landmines were registered, of which 430 were people belonging to minority ethnic groups (indigenous or Afro-descendant). Of these, 85 (19.7%) were women and 156 (36.2%) were under 18 years of age. Almost all people from ethnic minority groups were located in rural areas (n=427, 99.3%) and mortality was significantly higher compared to the mestizo population (mestizo 18.5% vs. individuals from ethnic minorities 29, 3%; p <0.001). After adjusting for sex, age group, active duty soldier status, rural area, and case volume for each geographic department, we found that ethnic minorities were more likely to die after suffering an antipersonnel mine injury (OR = 2.03; 95% CI 1.61-2.56; p <0.001). Discussion. We found an association between belonging to an ethnic minority and a higher probability of mortality with injuries caused by antipersonnel mines. These findings should encourage legislators in rural Colombia to work more diligently to reduce the harmful consequences of injuries caused by these devices in ethnic minority groups

Papel de distintas técnicas de imagen para identificar y localizar cuerpos extraños intraoculares relacionados con trauma ocular abierto: reporte de tres casos y revisión de la literatura / The role of various imaging techniques in identifying and locating intraocular foreign bodies related to open-globe injury: three case reports and literature review

ANTECEDENTES La ubicación precisa de un cuerpo extraño intraocular es crucial para el manejo de pacientes con trauma ocular abierto. La tomografía computarizada se usa habitualmente para detectar su ubicación en el segmento posterior. Reportamos tres casos con diferentes cuerpos extraños intraoculares en el segmento posterior, que fueron localizados con precisión mediante la tomografía computarizada y ecografía modo B. PRESENTACIÖN DEL CASO Presentamos tres casos con diferentes mecanismos de trauma, tipos de cuerpo extraño intraocular, síntomas clínicos y pronóstico visual. La tomografía computarizada determinó la ubicación exacta de todos los cuerpos extraños intraoculares en el segmento posterior. El ultrasonido modo B se realizó en un paciente con un cuerpo extraño intraocular no metálico. El primer caso tuvo una lesión ocular perforante con un cuerpo extraño intraorbitario; el caso dos y el caso tres presentaron diferentes tipos de cuerpos extraños intraoculares con pronóstico diferente. El manejo y el pronóstico fue distinto en todos los casos; todos se manejaron con éxito. La ubicación exacta de los cuerpos extraños intraoculares utilizando las diferentes modalidades de diagnóstico es importante en estos pacientes. Estos casos sirven como recordatorio de que el uso adecuado de las pruebas de imagen es indispensable en el contexto de un cuerpo extraño intraocular relacionado con trauma ocular abierto. CONCLUSIÓN Las diferentes técnicas de imágenes son muy importantes para la detección de un cuerpo extraño intraocular. La tomografía computarizada es una de las modalidades de imagen más simple y efectiva para la localización de cuerpos extraños intraoculares relacionadas con trauma ocular abierto.

BACKGROUND: Determining the precise location of intraocular foreign bodies is crucial for the management of patients with open-globe injury. Computed tomography is the most common method for detecting intraocular foreign bodies in the posterior segment. In this article, we describe three cases of open-globe injury with different types of intraocular foreign bodies in the posterior segment that were accurately located using computed tomography scans and B-scan ultrasonography. CASE PRESENTATION: Each of the three cases of open-globe injury described in this report had different types of ocular trauma, clinical symptoms, and intraocular foreign bodies. Computed tomography scans showed the exact location of the intraocular foreign bodies in the posterior segment in two of the three cases. A B-scan ultrasound was used to determine the location of a non-metallic intraocular foreign body in the third case. All three patients had intraocular foreign bodies, and one of them had an additional orbital foreign body. Case 1 had a perforating eye injury with the additional intraorbital foreign body; Cases 2 and Case 3 had different types of intraocular foreign bodies and prognoses. Various treatment approaches were used, ranging from observation to surgery, depending on the location of the intraocular foreign bodies, and all cases were successfully managed. These three cases show that proper use of various types of imaging tests is indispensable in the context of an intraocular foreign body related to open-globe injury. CONCLUSION: Imaging techniques are crucial for the detection of an intraocular foreign body, and computed tomography is one of the simplest and most useful, especially in cases of open-globe injury.

Effects of Blast Wave-induced Biomechanical Changes on Lung Injury in Rats / 生物医学与环境科学（英文）

Objective@#To observe the dynamic impacts of shock waves on the severity of lung injury in rats with different injury distances.@*Methods@#Simulate open-field shock waves; detect the biomechanical effects of explosion sources at distances of 40, 44, and 48 cm from rats; and examine the changes in the gross anatomy of the lungs, lung wet/dry weight ratio, hemoglobin concentration, blood gas analysis, and pathology.@*Results@#Biomechanical parameters such as the overpressure peak and impulse were gradually attenuated with an increase in the injury distance. The lung tissue hemorrhage, edema, oxygenation index, and pathology changed more significantly for the 40 cm group than for the 44 and 48 cm groups. The overpressure peak and impulse were significantly higher for the 40 cm group than for the 44 and 48 cm groups ( < 0.05 or < 0.01). The animal mortality was significantly higher for the 40 cm group than for the other two groups (41.2% . 17.8% and 10.0%, < 0.05). The healing time of injured lung tissues for the 40 cm group was longer than those for the 44 and 48 cm groups.@*Conclusions@#The effects of simulated open-field shock waves on the severity of lung injuries in rats were correlated with the injury distances, the peak overpressure, and the overpressure impulse.

Maxillofacial gunshot and blast injuries seen in a tertiary military hospital

@#<p><strong>OBJECTIVE: </strong>To describe the incidence, pattern, and severity of maxillofacial trauma among patients who sustained gunshot and blast injuries of the maxillofacial region in a tertiary military hospital.</p><p><strong>METHODS:</strong></p><p>            <strong>Design:</strong>            Retrospective Case Series</p><p>            <strong>Setting:</strong>            Tertiary Military General Hospital</p><p>            <strong>Participants:</strong>  All patients admitted under the otorhinolaryngology service with</p><p>                                    gunshot and blast injuries to the face</p><p><strong>RESULTS: </strong>A total of 108 patients were admitted due to gunshot and blast injuries to the face from January 2010 to December 2015. Most sustained gunshot injuries (73, 67.6%) compared to blast injuries (35, 32.4%). Of 108 patients, 71 had maxillofacial fractures (65.7%) while the remaining 37 only had soft tissue injuries (34.3%). Majority of those with maxillofacial fractures had single bone involvement (52, 72.2%); the rest had two or more bones affected (19, 27.8%) The most common bone injured was the mandible (77.5%), followed by the maxilla (35.2%), zygoma (12.7%), and others (frontal, nasal, and temporal bones) at 5.6%.</p><p><strong>CONCLUSION:</strong>       Gunshot injuries had a higher incidence than blast injuries among military personnel with projectile injuries to the face seen during the study period. There were more fractures and combinations of fractured bones affected in gunshot injuries, although the breakdown of soft tissue injuries was similar among those with gunshot and blast injuries. However, the relation of injury patterns and severity to gunshot or blast etiology, or to other factors such as protective gear, cannot be established in this present study.</p><p> </p><p><strong>KEYWORDS: </strong>gunshot injuries; blast injuries; maxillofacial; projectile</p>

Apoptotic mechanisms in rabbits with blast-induced acute lung injury

Abstract Purpose: To investigate the apoptotic mechanisms in rabbits with blast-induced acute lung injury (ALI). Methods: A total of 40 rabbits were randomly divided into a blank control group (A, n=10) and an experimental group (EXP, n=30). Explosion-induced chest-ALI models were prepared and sampled at different time points (4, 12, and 24h after modeling, T1-T3) to test the lung dry weight/wet weight ratio (W/D) and arterial oxygen pressure (PaO2), apoptosis of lung tissue by the TUNEL assay, and Caspase-3, Bax, and Bcl-2 levels by immunohistochemical analysis. Furthermore, lung tissue was sampled to observe pathological morphology by microscopy. Results: Under a light microscope, Group EXP exhibited obvious edema in the pulmonary interstitial substance and alveoli, a large number of red blood cells, inflammatory cells, and serous exudation in the alveolar cavity, as well as thickening of the pulmonary interstitial fluid. Compared to Group A, the W/D ratio was significantly increased in Group EXP (P<0.01), while PaO2 was significantly reduced (P<0.01). The apoptosis index was significantly increased (P<0.01), and caspase-3 and Bax/Bcl-2 levels were increased (P<0.01). Conclusion: Apoptosis plays an important role in the occurrence and development of acute lung injury in rabbits by participating in lung injury and promoting the progression of ALI.

Pirotecnia: lesiones graves de mano asociadas a explosión de un tipo de dispositivo (megapetardo/superbomba) / Pyrotechnics: severe hand lesions associated to the explosion of a certain device (megafirecrackers/superbombs)

Resumen Introducción: el uso de fuegos artificiales y dispositivos de pirotecnia forma parte de celebraciones y espectáculos públicos en todo el mundo. En Uruguay, su uso se encuentra concentrado en los meses estivales en eventos públicos y privados. Hay normativas para su uso, la importación y venta está regulada. En el verano de 2014-2015 hubo cuatro niños con lesiones graves de mano producidas por explosivos. Todas en circunstancias similares, compartieron el mismo mecanismo lesional y vinculados a un único dispositivo. En el año 2016 hubo más niños con iguales injurias. Objetivo: comunicar una serie de niños con injurias provocadas por un tipo de explosivo de pirotecnia con un patrón diferente al conocido previamente. Resultados: n=6. Todos varones, cinco adolescentes. Los seis presentaron lesiones severas en manos con amputación de uno o varios dedos, determinando secuelas estéticas y funcionales. Discusión: se identifica los dispositivos con alto contenido en pólvora y el mal uso de los mismos como factores asociados a las lesiones graves de mano. Se realizó una campaña desde la Sociedad Uruguaya de Pediatría, el Departamento de Emergencia Pediátrica, el Ministerio de Salud y otras autoridades para abordar este problema. Se prohíbe la venta de ese dispositivo. Conclusiones: la utilización de dispositivos de pirotecnia con alto contenido de pólvora como el megapetardo o superbomba puede determinar lesiones graves de mano, mutilantes y secuelas permanentes. No se recomienda la manipulación de fuegos artificiales por parte de los niños. El cumplimiento de las normativas vigentes y el correcto uso de los mismos podrían contribuir a disminuir estas injurias.

Summary Introduction: the use of fireworks and pyrotechnic devices are ways of public entertainment and celebration around the world. In Uruguay, they are more frequently used during summer-time in public and private events. Usage, import and sales are regulated by law. In summer 2014-2015 four children presented severe hand injuries caused by blasts, all of which occurred under similar conditions, shared the same injury mechanism and were linked to a specific device. In 2016 there were more children with similar lesions. Objective: to report a series of children with hand lesions caused by a certain type of pyrotechnic device with a pattern that was different from the one previously known. Results: n=6. All of them males 5 adolescents. The 6 children studied presented severe lesions in hands with amputation of 1 or several fingers, which resulted in aesthetic and functional sequelae. Discussion: devices with a high dose of gunpowder and their incorrect use are identified as factors associated to severe lesions. The Uruguayan Society of Pediatrics, the Pediatrics Emergency Department and the Ministry of Health, among other authorities, conducted a campaign to address this issue. The sale of this device is prohibited. Conclusions: the use of pyrotechnic devices with a high dose of gunpowder such as mega firecrackers or superbombs can result in severe hand lesions, mutilation and permanent sequelae. The handling of fireworks by children is not recommended. Fulfillment of updated regulations and the correct use of fireworks might contribute to diminishing these injuries.

Protocolo en el tratamiento de lesiones causadas por ondas expansivas: impacto sobre el diagnóstico tardío y una mejor oportunidad de manejo en un hospital académico nivel III ­ IV de atención / Protocol on the treatment of blast injuries: impact on late diagnosis and better chance of care in an III- IV level academic hospital

Introducción: Las lesiones producidas por ondas expansivas comprometen diferentes áreas anatómicas por su mecanismo de lesión y se traducen en traumatismos severos. En Colombia, las principales causas de estas lesiones las constituyen situaciones de guerra y ataques terroristas puesto que el país se ha visto inmerso en la violencia durante varios años. Material y Métodos:Debido a la severidad y el compromiso de áreas resultantes de ese tipo de eventos, se diseñó e implemento un protocolo de atención que se propuso realizar lo siguiente: 1) Aplicar la evaluación primaria y secundaria del paciente, según los lineamientos del Soporte Vital Avanzado en Trauma del Colegio Americano de Cirujanos. 2) Hacer la evaluación sistemática por áreas anatómicas por parte del departamento quirúrgico, orientándola hacia el examen de las lesiones descritas con mayor frecuencia. 3) Llevar a cabo posteriormente una valoración de las lesiones específi cas de acuerdo con las especialidades relacionadas. Para identifi car las lesiones más frecuentes, se rea-lizó un análisis retrospectivo de los casos registrados en el Hospital Universitario de Neiva, centro de referencia para el suroccidente de Colombia. Resultados: Durante ese periodo, se atendieron 35 pacientes cuyas áreas anatómicas comprometidas más frecuentes fueron las extremidades inferiores (con un registro del 60% de los casos), el abdomen (54,3%) y el tórax (42,9%). La mor-talidad general del grupo fue de 9,1%. Después de la implementación, se demostró una mejoría en la oportunidad de evaluación por cirugía general y se identifi caron 6 pacientes con diagnósticos tardíos, previos a la implementación del protocolo. Conclusión: Este estudio determinó que la implementación de una revisión secuencial y un protocolo sistemático permiten mejorar la tasa de diagnósticos tardíos optimizando la evaluación diagnostica y el abordaje terapéutico.

Introduction: Blast injuries, due to their mechanism, involve different anatomical areas and result in severe trauma. In Colombia, the main situation causing blast injuries is war and terrorist attacks as well, since by decades, this country has been historically immersed in violence. Materials and method: Due to severity of lesions and involvement of different areas during such events, a protocol of care was designed and implemented, aiming to perform the following: 1) Patient ́s primary and secondary evaluation according to the guidelines of the Advanced Trauma Life Support of the American College of Surgeons Committee on Trauma. 2) A systematic evaluation by anatomical areas by the department of surgery, focusing in the examination of more common lesions described. 3) To carry out an evaluation of the specifi c injuries, according to related spe-cialties. For identifi cation of the most common injuries, we carried out a retrospective analysis of cases recorded during 5 years at Neiva University Hospital, a referral center for southwest Colombia. Results: During this period of time, in 35 treated patients, the most frequent anatomic areas involved were the lower limbs (60% of cases), abdomen (54,3%) and chest (42,9%). The overall group mortality was 9,1%. After implementation of the protocol, chances of evaluation by general surgery was improved. Six patients with late diagnosis prior to protocol implementation were identifi ed. Conclusion: This study showed that the implementation of a sequential review and a systematic protocol can improve the rate of late diagnosis by optimizing the diagnostic evaluation and the therapeutic approach.

Damage of vascular endothelial barrier induced by explosive blast and its clinical significance / 中华创伤杂志(英文版)

In recent years, injuries induced by explosive blast have got more and more attention owing to weapon development and frequent terrorist activities. Tear, bleeding and edema of tissues and organs are the main manifestations of blast shock wave damage. Vascular endothelial barrier is the main defense of tissues and organs' integrity. This article aims to discuss possible mechanisms of endothelial barrier damage induced by explosive blast and main manifestations of blood brain barrier, bloodeair barrier, and intestinal vascular barrier impairments. In addition, the main regulatory factors of vascular permeability are also summarized so as to provide theoretical basis for prevention and cure of vascular endothelial barrier damage resulting from explosive blast.

Fatal accident due to anti-personnel ARGES EM01 rifle grenade explosion / 中华创伤杂志(英文版)

During the process of unsealing an old ammunition box in order to destroy it, a 42-year-old ammunition technician was fatally injured due to an anti-personnel ARGES EM01-type rifle grenade detonation. The explosion took place in the victim's hands, in point-blank range. This report aimed to show the anatomical position, the severity and the dispersion extent of the multiple injuries in the human body due to the detonation, and draw firm conclusions regarding the position of the human body and the circumstances prevailing at the moment of the explosion.

Comment on the "fatal accident due to anti-personnel ARGES EM01 rifle grenade explosion" / 中华创伤杂志(英文版)

Explosion has become one of the most common causes of death of the combat casualties. I made a comment on one case of autopsy whose cause of death was the accidental denotation of a 355 g rifle grenade and reviewed the clinical approaches and strategies of the blast injury.

Description of blast injuries: literature review, case report and proposal for a new classification / Descripción de lesiones por explosivos: revisión de la literatura, reporte de caso y propuesta de nueva clasificación

After reviewing the medical literature of various classifications of blast injuries, we present a proposal called the Bogotá Classification, aimed at the study of cadavers with injuries present in cases of death caused by explosion. We also present a case that occurred in a residence in the city of Bogotá involving an improvised explosive device, resulting in three deaths.

Luego de la revisión de la literatura médica, en relación con las diferentes clasificaciones de lesiones por explosivos, se presenta una propuesta denominada Clasificación Bogotá, dirigida al estudio en cadáveres de las lesiones presentes en casos de muertes por explosión. Se presenta además un caso ocurrido en la ciudad de Bogotá, D.C., donde, en una residencia, ocurre una detonación de artefactos explosivos caseros y como consecuencia se presentan de tres muertes.

Development of a new biomechanical indicator for primary blast-induced brain injury / 中华创伤杂志(英文版)

Primary blast-induced traumatic brain injury (bTBI) has been observed at the boundary of brain tissue and cerebrospinal fluid (CSF). Such injury can hardly be explained by using the theory of compressive wave propagation, since both the solid and fuid materials have similar compressibility and thus the intracranial pressure (ICP) has a continuous distribution across the boundary. Since they have completely different shear properties, it is hypothesized the injury at the interface is caused by shear wave. In the present study, a preliminary combined numerical and theoretical analysis was conducted based on the theory of shear wave propagation/reflection. Simulation results show that higher lateral acceleration of brain tissue particles is concentrated in the boundary region. Based on this fnding, a new biomechanical vector, termed as strain gradient, was suggested for primary bTBI. The subsequent simple theoretical analysis reveals that this parameter is proportional to the value of lateral acceleration. At the boundary of lateral ventricles, high spatial strain gradient implies that the brain tissue in this area (where neuron cells may be contained) undergo significantly different strains and large velocity discontinuity, which may result in mechanical damage of the neuron cells.

Shock tubes and blast injury modeling / 中华创伤杂志(英文版)

Explosive blast injury has become the most prevalent injury in recent military conflicts and terrorist attacks. The magnitude of this kind of polytrauma is complex due to the basic physics of blast and the surrounding environments. Therefore, development of stable, reproducible and controllable animal model using an ideal blast simulation device is the key of blast injury research. The present review addresses the modeling of blast injury and applications of shock tubes.

The past and present of blast injury research in China / 中华创伤杂志(英文版)

With the increasing incidence of blast injury, the research on its mechanisms and protective measures draws more and more attention. Blast injury has many characteristics different from general war injuries or trauma. For example, soldiers often have various degrees of visceral injury without significant surface damage, combined injuries and arterial air embolism. Researchers in China began to investigate blast injury later than the United States and Sweden, but the development is so fast that lots of achievements have been gained, including the development of biological shock tube, the mechanisms and characteristics of blast injury in various organs, as well as protective measures under special environments. This article reviews the past and current situation of blast injury research in China.

Blast-induced traumatic brain injury: a new trend of blast injury research / 中华创伤杂志(英文版)

Blast injury has become the major life- and function-threatening injuries in recent warfares. There is increased research interest in the mental disorders caused by blast-induced traumatic brain injury (bTBI), which has been proved as one of the "signature wounds" in modern battlefield. We reviewed the recent progresses in bTBI-related researches and concluded that the new era of blast injury research has shifted from the traditional physical impairments to cognitive dysfunctional/mental disorders that are proved to be more related to the outcome of combat casualty care.