Injury
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Multicenter Study
Penetrating oesophageal injury: a contemporary analysis of the National Trauma Data Bank.
Oesophageal trauma is uncommon. The aim of this study was to conduct a descriptive analysis of penetrating oesophageal trauma and determine risk factors for oesophageal related complications and mortality in the National Trauma Data Bank (NTDB). ⋯ Most deaths in penetrating oesophageal trauma occur in the first 24 h due to severe associated injuries. Primary repair was the most common intervention, followed by drainage and resection. Oesophageal related complications were not found to significantly increase mortality and time to first oesophageal related procedure did not affect outcomes in this subset of patients from the NTDB.
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Review
Application of scaffolds for bone regeneration strategies: current trends and future directions.
Scaffolds are extensively used in surgery to replace missing bone and to achieve bony union and fusion. An ideal scaffold should not only maintain, induce, and restore biological functions where cells, extracellular matrix, and growth factors are needed, but also have the right properties with respect to degradation, cell binding, cellular uptake, non-immunogenicity, mechanical strength, and flexibility. Here we examine both the basic science behind the development of scaffolds and comprehensively and systematically review the clinical applications.
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Cartilage injuries have a high incidence and a high impact on society. In an attempt to fulfill patients' expectations and successfully treat this pathology, various techniques have been developed over the years. Treatments proposed for cartilage lesions are described with their rationale and indications, ranging from conservative measures to surgical approaches, reparative or regenerative. ⋯ Randomized controlled trials are necessary to evaluate new regenerative approaches, to show clearly advantages and disadvantages with respect to the more traditional procedures, besides their potential, limits, and indications to improve the treatment of patients affected by chondral and osteochondral lesions. Since clear and commonly accepted treatment algorithms are not available in the literature, the massively increasing number of controversial results may be confusing for the orthopaedic surgeon who has to choose the proper management of patients with cartilage lesions. Thus, the results obtained through the study of the authors' 20 years' experience in cartilage treatment were analyzed to give some indications on the potential and limits of different treatment approaches available in clinical practice.
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A key challenge at a major incident is to quickly identify those casualties most urgently needing treatment in order to survive - triage. The UK Triage Sieve (TS) advocated by the Major Incident Medical Management (MIMMS) Course categorises casualties by ability to walk, respiratory rate (RR) and heart rate (HR) or capillary refill time. The military version (MS) includes assessment of consciousness. We tested whether the MS better predicts need for life-saving intervention in a military trauma population. Ideal HR, RR and Glasgow Coma Score (GCS) thresholds were calculated. ⋯ The MS is more sensitive than the TS. Major incident planners utilising the Sieve should consider adopting the military version as their first line triage tool. If validated, altering the HR and RR thresholds may further improve the tool.