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Copyright of Die Radiologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The text discusses the case of a patient who experienced pneumopericardium because of a traumatic incident. It discusses pneumopericardium's causes, symptoms, and complications, including tamponade symptoms and imaging modalities, to confirm the diagnosis and assess complications. Present various treatment options emphasize the importance of ongoing monitoring and damage control principles. Methods: Retrieved pneumopericardium cases with complete clinical databases (Pubmed, Medline) and summarised the clinical symptoms and prognosis of different treatment schemes. Results: A 33-year-old male patient, after a suicide attempt, fell from a height estimated at 15 m. The patient was intubated at the scene and mechanically ventilated. Initial assessment revealed signs of tension pneumothorax, which was decompressed and stabilized. Subsequent deterioration led to the discovery of pneumopericardium through diagnostic imaging. Conclusions: The case highlights the need for a comprehensive and multidisciplinary approach to address the complex nature of injuries associated with pneumopericardium. It examines the principles of damage control, which focus primarily on the patient's general condition, leaving some injuries for later treatment. [ABSTRACT FROM AUTHOR]

Hemorrhagic shock remains a leading cause of preventable death worldwide, with mortality patterns varying significantly based on injury mechanisms and severity. This comprehensive review examines the complex pathophysiology of hemorrhagic shock, focusing on the temporal evolution of inflammatory responses, biomarker utility, and evidence-based therapeutic interventions. The inflammatory cascade progresses through distinct phases, beginning with tissue injury and endothelial activation, followed by a systemic inflammatory response that can transition to devastating immunosuppression. Recent advances have revealed pattern-specific responses between penetrating and blunt trauma, necessitating tailored therapeutic approaches. While damage control resuscitation principles and balanced blood product administration have improved outcomes, many molecular targeted therapies remain investigational. Current evidence supports early hemorrhage control, appropriate blood product ratios, and time-sensitive interventions like tranexamic acid administration. However, challenges persist in biomarker validation, therapeutic timing, and implementation of personalized treatment strategies. Future directions include developing precision medicine approaches, real-time monitoring systems, and novel therapeutic modalities while addressing practical implementation barriers across different healthcare settings. Success in hemorrhagic shock management increasingly depends on integrating multiple interventions across different time points while maintaining focus on patient-centered outcomes. [ABSTRACT FROM AUTHOR]

The treatment strategy for blast injuries is closely linked to the clinical outcome of blast injury casualties. However, the application of military surgery experience to blast injuries caused by production safety accidents is relatively uncommon. In this study, the authors present 2 cases of blast injuries caused by one gas explosion, both cases involved individuals of the same age and gender and experienced similar degree of injury. The authors highlight the importance of using a military surgery treatment strategy, specifically emphasizing the need to understand the concept of damage control and disposal. It is recommended that relevant training in this area should be strengthened to improve the clinical treatment of such injuries. This study provides a valuable reference for healthcare professionals dealing with blast injuries.

Acute traumatic pancreatitis is one of the etiological forms of acute pancreatitis, the main cause of the development of which is mechanical trauma to the pancreas. A clinical case of successful treatment of a patient with acute traumatic pancreatitis developed as a result of a shrapnel thoracoabdominal injury with pancreatic damage and its complications using a multidisciplinary approach is presented. The possibilities of implementing the tactics of “damage control” at all stages of medical care are demonstrated.

Background. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used worldwide to stop bleeding in trauma and wounds in patients with hemorrhagic shock. REBOA allows for the hemodynamic stabilization, patient transportation and final bleeding control. The study aims to demonstrate the capabilities of REBOA as a method of bleeding control in the wounded with hemorrhagic shock in the context of war in Ukraine. Materials and methods. Five AFU servicemen who sustained mine-blast wounds in the Eastern Ukraine as a result of shelling by Russian troops were delivered with signs of internal bleeding and hemorrhagic shock to the primary and secondary levels of medical care (Role 1, 2). The REBOA balloon catheter was inserted and inflated by surgeons working in stabilization centers or advanced surgical teams. Upon admission, all patients underwent chest and abdominal ultrasound according to the FAST protocol. We used COBRA-OS 4 Fr and ER-REBOA 7 Fr balloon catheters. The positioning of the balloon in the aorta was performed according to external anatomical landmarks (3 cases) and ultrasound (2 cases). In all clinical cases, the balloon catheter was placed in zone I. In one case, the balloon was moved from zone I to zone III (control of the source of bleeding). The duration of aortic occlusion ranged from 15 to 50 minutes. Immediately after removal of the introducer, manual compression of the puncture site was used (3 cases) or suturing of the arteriotomy (2 cases). Results. The sources of bleeding in our clinical cases were injuries of the iliac vessels (2 cases), the renal artery (1 case), and injuries of the inferior vena cava and liver (2 cases). Four patients were evacuated to a higher level of medical care after the REBOA was installed. In one case, there were complications from vascular access (femoral artery thrombosis). We were unable to save one wounded soldier, most likely due to the delay in evacuation from the previous stage, the severity of injury, and massive blood loss. Conclusions. As our observations have shown, the use of REBOA in combat conditions allows not only to stabilize hemodynamics in the wounded with severe combined trauma and bleeding but also to conduct a successful evacuation to a higher level of medical care to stop bleeding ultimately. REBOA can be successfully used at the prehospital stage. This requires clearly defined indications for the technique’s use, training of medical personnel, and provision of balloon catheters to medical units of the Armed Forces of Ukraine.

Reinforced concrete bridge bents with double columns in bridge substructures are commonly used, but it has suffered severe damage during strong earthquakes. The seismic retrofit with structural fuses is used to effectively mitigate seismic damage of bridge bents. To obtain the displacement ductility demand for dual systems including the primary structure (PS) and structural fuses (SF), the corresponding ductility demand factor spectra were developed. The interaction between the PS and SF is described by defining two parameters of dual systems: the yield displacement ratio (α) and the initial stiffness ratio (β), and the influence of α, β, and strength reduction factor on the ductility demand factor spectra are also analyzed. For seismic retrofitting in bridge bents, buckling-restrained braces (BRBs) are used as energy dissipation fuses, and the steel core lengath of BRBs with three configurations forms, including diagonal, inverted-V, and toggle systems, are also explored. Then, based on the structural fuses concept and ductility demand factor spectra of dual systems, a performance-based seismic design procedure is proposed for bridge bents retrofitted with BRBs to ensure that the bridge bents maintain the target ductility under design-level earthquakes. Finally, the procedure was utilized to design the bridge bents with BRBs, and the procedure's feasibility was verified by nonlinear time-history analysis. [ABSTRACT FROM AUTHOR]

The article focuses on the impact of damage control strategies on the suitability of organs for donation after major trauma. Topics include the role of trauma patients in organ donation, the effects of damage control surgery on organ viability, and the ongoing efforts to address organ shortages through improved donor selection and surgical techniques.

Shaping and assembling contemporary external fixators rapidly for the severe mandibular fractures remains a challenge, especially in emergency circumstance. We designed a novel external fixator that incorporates universal joints to provide the stabilization for mandibular comminuted fractures. This study aims to confirm the efficacy of this novel external fixator through biomechanical tests in vitro and animal experiments. In vitro biomechanical tests were conducted using 6 fresh canine with mandibular defect to simulate critical comminuted fractures. Three mandibles were stabilized by the novel external fixator and other mandibles were fixed by 2.5 mm reconstruction plates. All fixed mandibles were subjected to loads of 350 N on the anterior regions of teeth and 550 N on the first molar of the unaffected side. The stability was evaluated based on the maximum displacement and the slope of the load-displacement curve. In animal experiments, 9 beagles with comminuted mandibular fractures were divided into 3 groups, which were treated with the novel external fixation, reconstruction plate, and dental arch bar, respectively. The general observation, the changes in animals' weight, and the surgical duration were recorded and compared among 3 groups. The CT scans were performed at various intervals of 0 day (immediately after the surgery), 3 days, 7 days, 14 days, 21 days, and 28 days to analyze the displacement of feature points on the canine mandible and situation of fracture healing at 28 days. The statistical significance was assessed by the two-way analysis of variance test followed by the Bonferroni test, enabling multiple comparisons for all tests using GraphPad Prism10.1.0 (GraphPad Inc, USA). The outcomes of the biomechanical tests indicated that no statistically significant differences were found in terms of the maximum displacement (p = 0.496, 0.079) and the slope of load displacement curves (p = 0.374, 0.349) under 2 load modes between the external and internal fixation groups. The animal experiment data showed that there were minor displacements of feature points between the external and internal fixation groups without statistic difference, while the arch bar group demonstrated inferior stability. The CT analysis revealed that the best fracture healing happened in the internal fixation group, followed by the external fixation and arch baring at 28 days after fixation. The external fixation group had the shortest fixation duration (25.67 ± 3.79) min compared to internal fixation ((70.67 ± 4.51) min, p < 0.001) and arch baring ((42.00 ± 3.00) min, p = 0.046). The conclusion of this study highlighted the efficacy and reliability of this novel external fixator in managing mandibular fractures rapidly, offering a viable option for the initial stabilization of comminuted mandibular fractures in the setting of emergency rescue. [ABSTRACT FROM AUTHOR]

Background: Little is known about the efficacy of damage control (DC) surgery in the management of lower limb trauma. Here we compared the clinical parameters and complication rates of such patients received either DC or emergency comprehensive (EC) surgery treatment. Methods: This study is a retrospective study on patients with lower limb trauma that received surgical treatment. Data of 120 patients were divided into DC and EC surgery groups. Clinical parameters obtained at hospital admission and complications during follow-up were analyzed. Injury Severity Score (ISS), Gustilo classification and Mangled Extremity Severity Score (MESS) were used to assess trauma severity, open fractures and viability of injured limb, respectively. Results: Age, sex, ISS, fracture type, injury site, MESS, operation time, blood loss, pulmonary and cranial injuries were compared. We found that patients in the DC group had more severe injury as reflected by the higher injury severity score (ISS) (28.1 ± 10.9 vs 21.3 ± 7.4, P

Recent earthquakes have demonstrated that code-conforming modern (i.e. post-1970s) reinforced concrete (RC) buildings can satisfy life safety performance objectives. However, the accumulated earthquake damage in these modern buildings raised concerns about their performance in future events, contributing to widespread demolition and long-term closure of damaged buildings. The economic and environmental impacts associated with the demolition and long-term closure of modern buildings led to societal demands for improved design procedures to limit damage and shorten recovery time after earthquakes. To address societal demands, this study proposes a damage-control-oriented seismic design approach that targets functional recovery by ensuring structural component demands do not exceed the damage-control limit state (DLS) under design-level events. Herein, DLS is defined as the post-earthquake state beyond which the strength and deformation capacity of a structural component is compromised, and its performance in a future event cannot be relied upon without safety-critical repair. This study proposes a methodology to determine component deformation limits for the design of structures for damage control. Using the developed methodology, we propose component rotation limits for RC beams, columns, and walls. The seismic performance and capability of buildings designed using the proposed design approach to satisfy recovery-based performance objectives is demonstrated through nonlinear response history and recovery analyses (using the ATC-138 methodology) of four archetype frame buildings, designed per New Zealand standards to different beam deformation limits. The analyses show that building codes can achieve functional recovery using the proposed component deformation limits without the need for sophisticated recovery analyses. [ABSTRACT FROM AUTHOR]

Trauma and its morbidity and mortality is a leading public health problem. Since the 1980s, multiple changes have been introduced to the resuscitation of trauma patients, attempting to reduce early mortality, mainly due to hemorrhagic shock. This is how damage control resuscitation arises, a concept that involves treating the trauma patient with a physiological point of view, correcting acidosis, hypocalcemia, hypothermia, and coagulopathy, in addition to emphasizing the resolution of complex problems through simple surgical procedures. This article describes the fundamental concepts of damage control resuscitation that every general surgeon should understand and implement when facing a patient with severe trauma. [ABSTRACT FROM AUTHOR]

Trauma is a leading cause of morbidity and mortality worldwide. Developments in trauma care, from point of wounding to rehabilitation, have often been led and driven by military medical experiences in recent conflicts. Trauma mechanisms are manifold, affecting an omnifarious patient population indiscriminately, and potentially resulting in significant multisystem dysfunction or damage, sometimes permanently. The horizontal approach to trauma resuscitation, whereby a patient is assessed and treated by multiple specialists to prioritize management of life-threatening issues swiftly and concurrently, was exploited to good effect by clinicians at Camp Bastion in Afghanistan. This tactic is just one element of the dynamic and synchronous teamwork that this complex and challenging area of clinical practice demands. Similarly, the damage control approach deploys medical and surgical treatment strategies in parallel, balancing therapies in pursuit of physiological equipoise, aiming to reduce mortality and accepting the risk of morbidity. Damage control therapy embodies bold, yet nuanced, clinical care. [ABSTRACT FROM AUTHOR]

Hemorrhagic shock remains a leading cause of preventable death worldwide, with mortality patterns varying significantly based on injury mechanisms and severity. This comprehensive review examines the complex pathophysiology of hemorrhagic shock, focusing on the temporal evolution of inflammatory responses, biomarker utility, and evidence-based therapeutic interventions. The inflammatory cascade progresses through distinct phases, beginning with tissue injury and endothelial activation, followed by a systemic inflammatory response that can transition to devastating immunosuppression. Recent advances have revealed pattern-specific responses between penetrating and blunt trauma, necessitating tailored therapeutic approaches. While damage control resuscitation principles and balanced blood product administration have improved outcomes, many molecular targeted therapies remain investigational. Current evidence supports early hemorrhage control, appropriate blood product ratios, and time-sensitive interventions like tranexamic acid administration. However, challenges persist in biomarker validation, therapeutic timing, and implementation of personalized treatment strategies. Future directions include developing precision medicine approaches, real-time monitoring systems, and novel therapeutic modalities while addressing practical implementation barriers across different healthcare settings. Success in hemorrhagic shock management increasingly depends on integrating multiple interventions across different time points while maintaining focus on patient-centered outcomes.

Background: The Golden Hour Box (GHB), an iceless blood container designed for transfusion closest to the point of injury, is used by military medical teams in remote damage control resuscitation. While its performance is well‐established in hot environments, it remains underexplored in cold conditions, a significant consideration in emerging global conflict zones. Study Design and Methods: Four GHBs were preconditioned at +4°C or +18°C for 8 h and subsequently exposed to controlled laboratory simulated temperatures of −5, −15, and −25°C for 100 h. The study focused on their capability to maintain an internal temperature between +2 and +6°C, the recommended range for red blood cells unit storage and transport, using calibrated sensors for precise monitoring. Results: When exposed to negative Celsius temperatures, GHBs showed varied performance depending on preconditioning temperatures. When preconditioned at +4°C, GHBs maintained an internal temperature within the target range (+2 to +6°C) for 100 h at −5°C, 52 ± 1 h at −15°C, and 29 ± 4 h at −25°C. In contrast, the internal temperature of GHBs preconditioned at +18°C exceeded this range in less than 30 min, then dropped below 2°C more rapidly than those preconditioned at +4°C, occurring within 20 ± 2 h at −15 and 13 ± 1 h at −25°C. Conclusion: The GHB, when properly preconditioned, effectively maintains internal temperatures suitable for blood product transport in extreme cold. Future research, including analyses of blood performances, is still needed to validate these results in more realistic operational conditions for use in cold environments. [ABSTRACT FROM AUTHOR]

Introduction: Lactic acid is well studied in the trauma population and is frequently used as a laboratory indicator that correlates with resuscitation status and has thus been associated with patient outcomes. There is limited literature that assesses the association of initial lactic acid with post-operative morbidity and hospitalization costs in the orthopedic literature. The purpose of this study was to assess the association of lactic acid levels and alcohol levels post-operative morbidity, length of stay and admission costs in a cohort of operative lower extremity long bone fractures, and to compare these effects in the ballistic and blunt trauma sub-population. Methods: Patients presenting as trauma activations who underwent tibial and/or femoral fixation at a single institution from May 2018 to August 2020 were divided based on initial lactate level into normal, (< 2.5) intermediate (2.5–4.0), and high (> 4.0). Mechanism of trauma (blunt vs. ballistic) was also stratified for analysis. Data on other injuries, surgical timing, level of care, direct hospitalization costs, length of stay, and discharge disposition were collected from the electronic medical record. The primary outcome assessed was post-operative morbidity defined as in-hospital mortality or unanticipated escalation of care. Secondary outcomes included hospital costs, lengths of stay, and discharge disposition. Data were analyzed using ANOVA and multivariate regression. Results: A total of 401 patients met inclusions criteria. Average age was 34.1 ± 13.0 years old, with patients remaining hospitalized for 8.8 ± 9.5 days, and 35.2% requiring ICU care during their hospitalization. Patients in the ballistic cohort were younger, had fewer other injuries and had higher lactate levels (4.0 ± 2.4) than in the blunt trauma cohort (3.4 ± 1.9) (p = 0.004). On multivariate regression, higher lactate was associated with post-operative morbidity (p = 0.015), as was age (p < 0.001) and BMI (p = 0.033). ISS, ballistic versus blunt injury mechanism, and other included laboratory markers were not. Lactate was also associated with longer lengths of stay, and higher associated direct hospitalization cost (p < 0.001) and lower rates of home disposition (p = 0.008). Conclusion: High initial lactate levels are independently associated with post-operative morbidity as well as higher direct hospitalization costs and longer lengths of stay in orthopedic trauma patients who underwent fixation for fractures of the lower extremity long bones. Ballistic trauma patients had significantly higher lactate levels compared to the blunt cohort, and lactate was not independently associated with increased rates of post-operative morbidity in the ballistic cohort alone. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Aim and background: Vascular injuries are among the leading causes of exsanguination in trauma patients. However, complex surgical procedures are not appropriate for patients in critical physiological conditions. This paper aims to present practical suggestions for these situations through a review of how to improvise temporary vascular shunts (TVSs), suggestions on which vessels can be ligated, when to perform fasciotomies, and when to indicate primary amputation. Methods: A narrative review of the literature was performed, and authors' case images were employed to illustrate practical aspects regarding vascular damage control in limited resource environments. Results: Paramount tools for temporary hemostasis include the use of tourniquets for compressible vascular injuries, balloons for junctional injuries, and resuscitative endovascular balloon occlusion of the aorta (REBOA) for noncompressible trauma, while vascular shunts are the cornerstone for the urgent restoration of blood flow. Conclusion: Regarding vascular trauma, "damage control" surgery refers to obtaining expeditious bleeding control and restoring organ/limb perfusion while avoiding time-consuming surgical techniques. Clinical significance: When damage control in vascular trauma is required in environments with limited resources, such as geographically isolated locations or the battlefield in war zones, difficulties are often enhanced by the unavailability of devices, instruments, and surgical expertise in treating these potentially lethal injuries. This paper presents practical suggestions for these situations. [ABSTRACT FROM AUTHOR]

In order to evaluate the structural performance of repaired RC beams with partially debonded longitudinal rebars, structural experiments were conducted. In the experiments, real-scale and half-scale RC beam specimens underwent cyclic loading of 1.0% or less in terms of deformation angle, repaired with epoxy resin injection method, and multiple cyclic loading again. As a result of the experiments, damage was suppressed in specimens with partially debonded longitudinal rebars even after repairs. Further, the specimens with partially debonded longitudinal rebars exhibited high recovery of initial stiffness after repair compared to the specimen with bonded longitudinal rebars. In addition, from study of the costs required to repair cracks, it was confirmed that RC beams with partially debonded longitudinal rebars used smaller quantities of materials used for repairs and could potentially reduce repair cost by approximately 50% compared to RC beams having standard bonding properties. [ABSTRACT FROM AUTHOR]

Within the double-sided countersunk riveting process of aircraft wings with a composite wedge structure, riveting consistency is poor, and composite damage is severe, which seriously affects the performance and reliability of the aircraft structure. This paper used the principal stress method to establish a stress model of countersunk riveting, and, based on the analysis of the stress on the structure during the pressure-riveting process, a composite structure rivet was designed. A finite element simulation model of the double-sided countersunk riveting of composite wedge structures' composite rivets was established. The influences of the structure and the matching parameters of composite rivets on both the plastic flow of pressure riveting and the compressive stress of the structure during the pressure-riveting process were analyzed. The structural parameters and riveting process of composite rivets were optimized. The results show that the composite rivet structure could significantly reduce the contact-compressive stress at the riveting joint by more than 20%, thereby reducing the damage caused by the riveting to the composite material. For 4 mm rivets, an aperture of 4.04~4.06 mm can achieve precise relative interference riveting at 0.6% to 1.0%. Employing a 2.6 mm rivet elongation can exactly fill the countersunk hole of the wedge. [ABSTRACT FROM AUTHOR]

Copyright of Tesla Revista Científica is the property of Puerto Madero Editorial Academica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this paper, a new type of assembled RC beam–column joint with a beam-end steel cover-plate connection is proposed to achieve seismic toughness and damage control of the joint. Energy-dissipation plates with different structural forms are proposed, and a series of seismic performance indexes of the joints are calculated and analyzed by using the finite element method. The energy-dissipation plate with an arc notch can reach the yield condition faster, and the ultimate bearing capacity of the joint reaches the maximum. The bending design of energy-dissipation plates is carried out by calculating the demand bending moment, and energy-dissipation plates of different structural forms are simulated and verified. The results show that the proposed design formula can ensure that the bending moment at the beam end still maintains elastic deformation when the energy-dissipation plate yields. The important parameters affecting the bending moment of the weakened part in the middle of the energy-dissipation plate are analyzed. Finally, this paper also analyzes the important parameters affecting the seismic performance of the joints. The results show that the seismic performance of the newly assembled RC beam–column joints proposed in this paper is better than that of cast-in-place joints. Increasing the longitudinal reinforcement ratio appropriately can greatly improve the ultimate bearing capacity and ductility of the joints. Increasing the thickness of the energy-dissipation plate, increasing the strength of the energy-dissipation plate, increasing the axial compression ratio of the column, increasing the strength of the concrete, and increasing the strength of the shear web can improve the ultimate bearing capacity of the joints but also reduce their ductility. Under different axial compression ratios, the strain in the core area of the joints is low, and the compressive damage of the concrete is zero, which verifies the effectiveness of the damage-control design of the proposed model. [ABSTRACT FROM AUTHOR]

The hybrid emergency room (ER) system can provide resuscitation, computed tomography imaging, endovascular treatment, and emergency surgery, without transferring the patient. However, although several reports have demonstrated the effectiveness of the hybrid ER for trauma conditions, only a few case reports have demonstrated its usefulness for non-traumatic critical diseases. In this observational cohort study, we aimed to identify endogenous diseases that may benefit from treatment in the hybrid ER. We retrospectively reviewed the clinical characteristics of patients with non-traumatic conditions treated in a hybrid ER between August 2017 and July 2022 at our institution. Patients who underwent surgery, endoscopy, or interventional radiology (IR) in the hybrid ER were selected and pathophysiologically divided into a bleeding and non-bleeding group. The rate of shock or cardiac arrest, blood transfusion, and death within 24 h of admission or in-hospital death were compared among the groups using Fisher's exact test. Multivariable logistic regression analysis was performed to confirm the relationships among in-hospital mortality, transfusion, and hemorrhagic conditions in patients who underwent endoscopy and IR. Among the 726 patients with non-traumatic conditions treated in a hybrid ER system, 50 (6.9%) experienced cardiac arrest at or before admission to the hybrid ER, 301 (41.5%) were in shock, 126 (17.4%) received blood transfusions, 42 (5.8%) died within 24 h of admission to the hybrid ER, and 141 (19.4%) died in the hospital. Emergency surgery was performed in 39 patients (7 in the bleeding group and 32 in the non-bleeding group). Significantly more blood transfusions were administered in the bleeding group (71.4% vs. 18.8%, P = 0.01); there were no significant differences in the rate of shock or cardiac arrest, death within 24 h, or in-hospital death between groups. Endoscopy was performed in 122 patients (80 in the bleeding group and 42 in the non-bleeding group). The bleeding group had a significantly higher rate of shock or cardiac arrest (87.5% vs. 66.7%, P = 0.008) and rate of blood transfusion (62.5% vs. 4.8%, P < 0.0001); there was no significant difference in death within 24 h and in-hospital death between groups. IR was performed in 100 patients (68 in the bleeding group and 32 in the non-bleeding group). Significantly more blood transfusions were administered in the hemorrhage group (67.7% vs. 12.5%, P < 0.0001); there was no difference in the rate of shock or cardiac arrest, death within 24 h, or in-hospital death between groups. Multivariable analysis in patients who underwent endoscopy showed a trend toward more in-hospital deaths in non-hemorrhagic conditions than in hemorrhagic conditions (odds ratio = 3.8, 95% confidence interval: 0.88–17, P = 0.073); however, no significant relationship with in-hospital death was observed for any of the adjusted variables. Among endogenous diseases treated in the hybrid ER, there is a possible association between in-hospital mortality and hemorrhagic conditions. Future studies are needed to focus on diseases to demonstrate the effectiveness of the hybrid ER. [ABSTRACT FROM AUTHOR]

This paper presents the study of a single-sided column–tree connection with a replaceable buckling-restrained cover plate (BRCP) at a bottom flange to achieve rapid postearthquake repair for connections in the presence of concrete slabs. During major earthquakes, the bottom flange core plate of the BRCP yields and dissipates energy, and the connection rotates around the center of the top flange connection plate. The slip and yield moments of the proposed connection were theoretically calculated, and the design principle was proposed. Quasi-static loading tests were performed on four specimens. Moreover, the hysteresis behavior, failure modes, force–deformation hysteresis curves, force–deformation backbone curves, strain responses, energy dissipation capacity, and neutral axis position were obtained. Additionally, the influence of restrained forms, unbonded material, and neutral axis position on the hysteresis performance were analyzed. The results show that the two-piece restraint plate leads to extreme local bending of the core plate, the unbonded material on the restraint plate has little effect on the seismic performance, and the core plate undergoes larger deformation when the neutral axis is close to the top flange. Finally, finite-element models of the test specimens were established and validated using the test hysteretic curves and the failure modes to further investigate the test results. [ABSTRACT FROM AUTHOR]

Summary: Bolted connections are preferred in prefabricated steel structures with the advantages of quality control and convenient construction. An innovative type of earthquake‐resilient joint with slotted bolted connection (ERJ‐SBC) is proposed to achieve damage control and improve the ductile behavior of steel structures. The bending moment is assumed to be mainly transferred by the flange segments of SBC while the shear force is carried by the web segments. The energy dissipation capacity of ERJ‐SBC is provided by the initial frictional sliding and inelastic axial deformation of SBC under larger displacement. Design theory is proposed to ensure that inelastic deformation is concentrated in SBC while other structural members remain elastic. The influences of the length of slotted holes, bolt pretension, friction coefficient, and the thickness and width of the sliding plate are investigated through the numerical analysis of 44 FE examples. The calculation of the critical length of slotted holes for the ductile rotation behavior of ERJ‐SBC is derived and verified. Results demonstrate that the mechanism of bolted connection shifts from friction resistance to bearing resistance when bolts collide with slotted holes, and the friction slippage behavior with slotted holes benefits the hysteresis behavior, deformation capacity, and rotation behavior. The proposed calculation methods for the mechanical behavior of ERJ‐SBC could achieve good accuracy with simulation results. A reasonably well‐designed ERJ‐SBC could have good bearing capacity and rotation behavior, and it could also achieve damage control. [ABSTRACT FROM AUTHOR]

Purpose: Unstable pelvic ring injury can result in a life-threatening situation and lead to long-term disability. Established classification systems, recently emerged resuscitative and treatment options as well as techniques, have facilitated expansion in how these injuries can be studied and managed. This study aims to access practice variation in the management of unstable pelvic injuries around the globe. Methods: A standardized questionnaire including 15 questions was developed by experts from the SICOT trauma committee (Société Internationale de Chirurgie Orthopédique et de Traumatologie) and then distributed among members. The survey was conducted online for one month in 2022 with 358 trauma surgeons, encompassing responses from 80 countries (experience > 5 years = 79%). Topics in the questionnaire included surgical and interventional treatment strategies, classification, staging/reconstruction procedures, and preoperative imaging. Answer options for treatment strategies were ranked on a 4-point rating scale with following options: (1) always (A), (2) often (O), (3) seldom (S), and (4) never (N). Stratification was performed according to geographic regions (continents). Results: The Young and Burgess (52%) and Tile/AO (47%) classification systems were commonly used. Preoperative three-dimensional (3D) computed tomography (CT) scans were utilized by 93% of respondents. Rescue screws (RS), C-clamps (CC), angioembolization (AE), and pelvic packing (PP) were observed to be rarely implemented in practice (A + O: RS = 24%, CC = 25%, AE = 21%, PP = 25%). External fixation was the most common method temporized fixation (A + O = 71%). Percutaneous screw fixation was the most common definitive fixation technique (A + O = 57%). In contrast, 3D navigation techniques were rarely utilized (A + O = 15%). Most standards in treatment of unstable pelvic ring injuries are implemented equally across the globe. The greatest differences were observed in augmented techniques to bleeding control, such as angioembolization and REBOA, more commonly used in Europe (both), North America (both), and Oceania (only angioembolization). Conclusion: The Young-Burgess and Tile/AO classifications are used approximately equally across the world. Initial non-invasive stabilization with binders and temporary external fixation are commonly utilized, while specific haemorrhage control techniques such as pelvic packing and angioembolization are rarely and REBOA almost never considered. The substantial regional differences' impact on outcomes needs to be further explored. [ABSTRACT FROM AUTHOR]

Management of severely injured patients remains a challenge, characterised by a number of advances in clinical practice over the last decades. This evolution refers to all different phases of patient treatment from prehospital to the long-term rehabilitation of the survivors. The spectrum of injuries and their severity is quite extensive, which dictates a clear understanding of the existing nomenclature. What is defined nowadays as polytrauma or major trauma, together with other essential terms used in the orthopaedic trauma literature, is described in this instructional review. Furthermore, an analysis of contemporary management strategies (early total care (ETG), damage control orthopaedics (DCO), early appropriate care (EAC), safe definitive surgery (SDS), prompt individualised safe management (PRISM) and musculoskeletal temporary surgery (MuST)) advocated over the last two decades is presented. A focused description of new methods and techniques that have been introduced in clinical practice recently in all different phases of trauma management will also be presented. As the understanding of trauma pathophysiology and subsequently the clinical practice continuously evolves, as the means of scientific interaction and exchange of knowledge improves dramatically, observing different standards between different healthcare systems and geographic regions remains problematic. Positive impact on the survivorship rates and decrease in disability can only be achieved with teamwork training on technical and non-technical skills, as well as with efficient use of the available resources.

Abstract Swelling and migration of present clays make damage to the oil reservoirs due to low salinity waterflooding (LSWF) can induce serious problems in the case of oil recovery improvement and researchers are trying to solve this problem. The purpose of this work is to investigate the mechanism of two phenomena of swelling and migration clays in the porous media of a reservoir rock by injecting a different composition of LSWF using a glass micromodel and providing the appropriate composition and pattern of injection with the removal of damage. Proper water flooding design, application of efficient swelling inhibitors, and migration control are among the most important methods to overcome the problem of formation damage due to swelling and migration of clays. A series of static (bulk or bottle test) and dynamic tests were carried out using a micromodel with a coating of kaolinite and montmorillonite clays in the vicinity and injection of different low salt water compositions. The type and amount of these clays were selected based on the results of XRD and SEM mineralogical tests on real reservoir rock, FW and diluted FW, SW and diluted SW, solution of 1% zirconium oxychloride in 20 times diluted seawater (SI), and composition of nanofluid MgO, SiO2, and Al2O3 in 20 times diluted. In the studies conducted by the micromodel, only the images taken were used in the analysis of the mechanisms, but here, the input and output pressures of the micromodel were recorded with high-precision pressure transmitters, and by using the differential pressure, the permeability was calculated and the formation damage index was introduced. The overlap of the interpretation of the captured images and the changes of the numerical parameter of the damage index in all stages of injection of smart water composition was considered to evaluate the simultaneous and separate mechanisms of swelling and migration of clays. The results of the experiments in this research show that clay swelling has destructive effects on permeability, and migration due to the transfer of clays from the porous medium can have promising effects on reducing the damage index in some conditions. And it is necessary to use the swelling control compound during the flooding process, but the migration inhibitor compound is not always suitable. Gradual reduction of salinity is also introduced as a pattern to prevent swelling damage or clay migration. In general, in this study, the best design and fluid engineering for smart water injection with the least damage in the micromodel scale was presented.