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Hadi Khoshmohabat,1 Shahram Paydar,2 Alireza Makarem,1,3 Mohammad Yasin Karami,2 Niloofar Dastgheib,4 Seyed Ali Hossein Zahraei,4 Rohallah Rezaei,2 Golnoush Sadat Mahmoudi Nezhad21Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran; 2Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; 3Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran; 4Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IranIntroduction: Planning for management of bleeding in trauma injuries is very important. The initial purpose in emergency situations should be immediate establishment of an efficient hemostasis, principally in its topical application. In this study, we aimed to review the major relevant articles in the case of application of cellulose hemostatic agent on trauma injuries.Methods: We searched the online databases such as PubMed, MEDLINE, Wiley, EMBASE, ISI Web of Knowledge, and Scopus. Two reviewers independently searched and assessed the titles and abstracts of all articles.Results: Upon screening the titles and abstracts, 24 studies were identified for full-text review. The oxidized cellulose had the best clotting times, while it demonstrated low absorption ability. Surgical and thermosensitive chitosan hemostatic could be valuable for managing hemorrhage from liver injuries in trauma patients.Conclusion: Recently, the application of cellulose hemostatic agents has been one of the main improvements obtained for controlling bleeding in trauma injuries. However, generally according to the literature review, the decision about using each agent should be made on a case-by-case basis. However, it can be mentioned that the perfect hemostatic agent has not been still identified.Keywords: cellulose hemostatic agent, trauma, injury

Pelvic fracture is a result of devastating injuries and is usually encountered in conjunction with other life- threatening injuries. The aim of the current study was to determine the outcome determinants of patients with pelvic fractures referred to a large trauma center in southern Iran. This retrospective cross-sectional study was conducted in a level I trauma center over a period of three years from 2012 to 2015. We included all patients with pelvic fractures whose medical records had sufficient data. Data were compared between good condition and poor conditions. A total of 327 patients with mean age of 40.1 ± 19.7 years were included. Poor condition was defined as being associated with higher heart rate (p=0.002), lower systolic blood pressure (p

A novel cathode material of (Nd0.9La0.1)1.6Sr0.4Ni0.75Cu0.25O3.8 (NLSNC4), is synthesized by solid state reaction and is further investigated in combination with samarium doped ceria (SDC) as composite cathodes including 0, 10, 30, 50, and 70 of SDC electrolyte phase. The X‐ray diffraction analysis showed that NLSNC4 was produced in pure phase and was chemically compatible with SDC electrolyte. Electrical conductivities of single phase and composite cathode materials along with their electrochemical performances on SDC electrolytes in symmetric cells were measured by DC four‐probe method and electrochemical impedance spectroscopy (EIS), respectively. Results indicated that the maximum electrical conductivity is 135.56 S cm−1 at 350 °C, measured for single phase NLSNC4, sintered at 1,300 °C. Polarization resistance of pure NLSNC4 cathode was 2.71 Ω cm2 at 800 °C, and NLSNC4‐x wt.% SDC composite cathodes displayed Rp value of 0.35, 0.14, 0.12, and 0.32 Ω cm2 at 800 °C, for x = 10, 30, 50, and 70, respectively. [ABSTRACT FROM AUTHOR]

Abstract Background To describe a rare manifestation of mantle cell lymphoma (MCL) in conjunctiva, with clinical, hisologic, immunohistologic and genetic findings together with review of the Literature. Case presentation Most ocular adnexal lymphomas are extranodal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT). A few cases of ocular adnexal mantle cell lymphomas have been reported in the literature. We present a case of mantle cell lymphoma presenting as right conjunctival mass of at least three months duration in a 64-year-old man. Histopathologic examination showed a proliferation of monomorphous small-to-medium-sized lymphoid cells with cleaved nuclei in the subconjunctiva. By immunohistochemistry, the infiltrate was positive for CD20, CD5, BCL-2, cyclin D1, and the transcription factor SOX11. Fluorescent in situ hybridization demonstrated the presence of IGH-CCND1 fusion indicating t(11;14). Conclusion A rigorous approach to initial diagnosis and staging of small cell lymphomas of the ocular adnexa is needed. The recognition of ocular MCL requires appropriate immunohistochemical staining and/or genetic confirmation to differentiate this rare form of presentation of MCL from other more frequent small cell lymphomas.

Background: In the recent years, National Early Warning Score2 (NEWS2) is utilized to predict early on, the worsening of clinical status in patients. To this date the predictive accuracy of National Early Warning Score (NEWS2), Revised Trauma Score (RTS), and Trauma and injury severity score (TRISS) regarding the trauma patients' mortality rate have not been compared. Therefore, the objective of this study is comparing NEWS2, TRISS, and RTS in predicting mortality rate in trauma patients based on prehospital data set., Methods: This cross-sectional retrospective diagnostic study performed on 6905 trauma patients, of which 4191 were found eligible, referred to the largest trauma center in southern Iran, Shiraz, during 2022-2023 based on their prehospital data set in order to compare the prognostic power of NEWS2, RTS, and TRISS in predicting in-hospital mortality rate. Patients are divided into deceased and survived groups. Demographic data, vital signs, and GCS were obtained from the patients and scoring systems were calculated and compared between the two groups. TRISS and ISS are calculated with in-hospital data set; others are based on prehospital data set., Results: A total of 129 patients have deceased. Age, cause of injury, length of hospital stay, SBP, RR, HR, temperature, SpO2, and GCS were associated with mortality (p-value < 0.001). TRISS and RTS had the highest sensitivity and specificity respectively (77.52, CI 95% [69.3-84.4] and 93.99, CI 95% [93.2-94.7]). TRISS had the highest area under the ROC curve (0.934) followed by NEWS2 (0.879), GCS (0.815), RTS (0.812), and ISS (0.774). TRISS and NEWS were superior to RTS, GCS, and ISS (p-value < 0.0001)., Conclusion: This novel study compares the accuracy of NEWS2, TRISS, and RTS scoring systems in predicting mortality rate based on prehospital data. The findings suggest that all the scoring systems can predict mortality, with TRISS being the most accurate of them, followed by NEWS2. Considering the time consumption and ease of use, NEWS2 seems to be accurate and quick in predicting mortality based on prehospital data set., (© 2024. The Author(s).)

Early resuscitation using blood products is critical for patients with severe hemorrhagic shock. We aimed to develop and validate a new scoring system, hemorrhagic shock transfusion prediction (HSTP) score, to predict the need for massive transfusion (MT) in these patients, compared to the widely used Assessment of Blood Consumption (ABC) score. Trauma patients admitted to Emtiaz Hospital in Iran from 2017 to 2021 were retrospectively included. Patients assigned a code 1 or 2 according to the Emergency severity index (ESI) triage system have been divided into MT and non-MT groups. MT was defined as receiving ≥ 10 units of packed cells (PCs) in 24 h. Demographic information, admission vital signs, and lab results available within 15 min were compared between the groups. A new predictive score was developed using logistic regression of statistically significant parameters. Out of 1029 patients, 651 (63.3%) required MT. An arrival, diastolic blood pressure < 79.5 mm Hg, absolute lymphocyte count > 1850/μL, base excess < - 4.25, and blood glucose > 156 mg/dL were independent predictors included in the HSTP score. The sensitivity and specificity were 74.36% and 53.87% for the HSTP score, compared to 31.03% and 76.16% for the ABC score. Moreover, the positive and negative predictive values were 77.88% and 49.03% for the HSTP score, versus 74.15% and 33.66% for ABC. The new scoring system demonstrated higher sensitivity and improved positive and negative predictive values compared to the ABC score. This score can assist physicians in making accurate transfusion decisions quickly, but further prospective studies are warranted to validate its clinical utility., (© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)

This study explores the impact of A-site deficiency and Sr/Ca ratio on the electrochemical and crystallographic properties of a (Nd 0.2 Sr 0.7- x Ca x ) y Ti 0.95 Fe 0.05 O 3-δ hydrogen electrode for solid oxide cells under reducing and air atmospheres. 5% and 10% A-site deficient (Nd 0.2 Sr 0.7- x Ca x ) y Ti 0.95 Fe 0.05 O 3-δ ( x = 0.35-0.45, y = 1.05, 1) (referred to as 5NSCTF- x and 10NSCTF- x ) materials were studied, while the ratio between A-site cations was kept the same with both deficiencies. The results demonstrate that the extent of A-site deficiency and the Ca concentration in the A-site have a significant impact on the microstructure (sinterability), conductivity, and catalytic activity of electrodes. Segregation of Nd from the lattice with 5% A-site deficiency was observed as a result of thermal treatment at low pO 2 . Among the studied materials, the highest total electrical conductivity of porous electrode layer at 850 °C and in 97% H 2 + 3% H 2 O atmosphere was 4.8 S cm -1 observed for the Nd 0.2 Sr 0.35 Ca 0.35 Ti 0.95 Fe 0.05 O 3-δ (10NSCTF-35). The highest electrochemical performance was observed in the case of Nd 0.2 Sr 0.25 Ca 0.45 Ti 0.95 Fe 0.05 O 3-δ (10NSCTF-45), which showed a polarization resistance value equal to 0.19 Ω cm 2 after 100 h of stabilization at 800 °C in a humidified (1.7% H 2 O) H 2 atmosphere. The best electrochemical performance with 606 mW cm -2 power density at 850 °C in 98.3% H 2 + 1.7% H 2 O atmosphere was demonstrated by a 50 wt % Nd 0.2 Sr 0.25 Ca 0.45 Ti 0.95 Fe 0.05 O 3-δ + 50 wt % Ce 0.9 Gd 0.1 O 2-δ composite., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

Competing Interests: Declaration of competing interest The authors declare no conflict of interest.

Purpose: Prolonged mechanical ventilation (MV) subjects multiple trauma patients to ventilator-induced diaphragmatic dysfunction. There is limited evidence on the predictive role of diaphragm ultrasound (DUS) for weaning success in multiple trauma patients. Therefore, we evaluated Ultrasound of the diaphragm as a valuable indicator of weaning outcomes, in trauma patients., Material and Methods: This prospective cohort study included 50 trauma patients from September 2018 to February 2019. DUS was performed twice: upon ICU admission and the first weaning attempt. The diagnostic accuracy of indexes was evaluated by ROC curves., Results: The study included patients with a mean age of 35.4 ± 17.37, and 78% being male. The median injury severity score was 75 (42-75). The failure group exhibited significantly lower right diaphragmatic excursion (DE) compared to the success group (P = 0.006). In addition, the failure group experienced a significant decrease in both right and left DE from admission to the first attempt of weaning from MV (P < 0.001). Both groups showed a significant decrease in inspiratory and expiratory thickness on both sides during weaning from MV compared to the admission time (P < 0.001). The findings from the ROC analysis indicated that the Rapid shallow breathing index (RSBI) (Sensitivity = 91.67, Specificity = 100), respiratory rate (RR)/DE (Right: Sensitivity = 87.5, Specificity = 92.31), and RR/TF (Thickening Fraction) (Right: Sensitivity = 83.33, Specificity = 80.77) demonstrated high sensitivity and specificity in predicting weaning outcome., Conclusion: In the context of patients with multiple trauma, employing DUC and assessing diaphragmatic excursion, thickness, RR/DE index, RR/TF index, and RSBI can aid in determining successful ventilator weaning., (© 2024. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)