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Trauma is a leading cause of death and disability in low-income and middle-income countries. In Pakistan, limited reporting and absence of trauma registries restrict understanding of outcomes in Peshawar. To describe the patterns, severity, and in-hospital mortality of trauma at Khyber Teaching Hospital (KTH), Peshawar, during 5 years. This retrospective cohort (2018-2022) included all trauma admissions at KTH. Data on demographics, mechanism, Injury Severity Score (ISS), Revised Trauma Score (RTS), and Glasgow Coma Scale (GCS) Score were extracted. Logistic regression identified predictors of in-hospital death; annual trends were analyzed. Among 10 542 patients (mean age 32±19 years; 72% male), blunt trauma comprised 58%, penetrating injuries 23%, and burns 8%. Road traffic accidents (RTAs) caused half of all injuries, followed by falls (16%), and violence (15%). Overall mortality was 9.4% (n=995), decreasing from 10.8% in 2018 to 8.7% in 2022. Fatalities had higher median ISS (25 vs 9; p<0.001) and more severe traumatic brain injury (56% vs 18%; p<0.001). Independent predictors of death were age >60 years (OR 4.3; 95% CI 3.5 to 5.4), ISS >25 (OR 5.6; 4.5-6.9), systolic BP <90 mm Hg (OR 4.9; 3.9-6.2), and GCS Score <8 (OR 6.1; 4.9-7.7). RTS and Trauma and Injury Severity Score showed strong discrimination (Area under the curve (AUC)=0.90). Trauma mainly from RTAs remains a major cause of in-hospital death at KTH despite modest decline. High ISS, hypotension, and low GCS Score were strongest mortality predictors. Strengthened prehospital care, dedicated trauma centers, and a provincial registry are key to reducing preventable deaths in Khyber Pakhtunkhwa.
Though preventable, burns are the leading cause of trauma-related death in children under 4 years in South Africa and account for almost half of all pediatric trauma cases at Chris Hani Baragwanath Academic Hospital. We investigated the impact of an education-based pediatric hot water burns prevention program on the knowledge and behavior of caregivers in Soweto. We conducted a quasi-experimental nonequivalent controlled before-and-after intervention study with a 7-month follow-up. Households were randomly selected within purposively identified high-burden burns clusters. At baseline, household assessments and caregiver surveys captured burn history, burn risk, first aid knowledge, and household injury risk. Subsequently, all caregivers received structured education on pediatric burns, prevention measures, and first aid. At follow-up, the same households and individuals were reassessed to evaluate for knowledge and behavior change. A total of 242 intervention and 52 control households were assessed. There were no significant differences between the control and intervention households. Most households were severely overcrowded (70.8%, 208/294). Only 7.1% (21/294) had geysers, with 89.8% (264/294) dependent on manually boiled water for bathing, despite most households being electrified (97.9%, 288/294). Relative to baseline, there was a 30.8% (95% CI 22.2%-40.9%) increase in knowledge on the correct first aid for hot water burns postintervention. A 43.3% (95% CI 36.5%-50.5%) increase in stove tops being kept > 1.4 m off the ground, 40.3% (95% CI 30.0%-51.4%) increase in appropriately checking the temperature of bath water, 38.3% (95% CI 29.1%-48.4%) increase in ensuring pot handles are out of reach, and 23.5% (95% CI 15.8%-33.6%) decrease in handling of hot beverages while holding a child were also noted postintervention (all exact McNemar p < 0.001). There was no change in the number of households with childfree safe zones postintervention. Caregiver education was associated with significant improvements in caregiver knowledge and selected safety practices. Structural constraints, such as overcrowding, may limit the adoption of some positive behavioral changes, underscoring the need for additional system level intervention.
Trauma contributes significantly to the global burden of suffering and death, and interrupts the complex balance between hemostasis and the immune system; platelets are key in integrating hemostatic and immune functions. This review will provide an overview of how different types of traumatic injury including traumatic brain injury, hemorrhagic shock, and burns impact platelet function through both separate and interconnected mechanistic pathways. Moreover, this review will examine in detail the multiple manifestations of trauma-induced platelet dysfunction, including but not limited to impairments in platelet activation, adhesion, aggregation and degregulation of granule secretion patterns. In addition, this review will describe how these platelet defects alter the dual roles of platelets as regulators of immunothrombosis and systemic inflammation. At a cellular level, separate types of trauma converge on shared molecular signaling pathways while utilizing different pathophysiological pathways to produce a complex network of regulations that control how platelets function. The purpose of this review is to present a comprehensive synthesis of current literature to provide a more complete overview of the mechanisms involved with trauma-related platelet abnormalities and to provide a framework for developing platelet-targeted therapies in the future.
Trauma remains a leading cause of hospital admissions worldwide, particularly in low- and middle-income countries. Brazil's dual healthcare system reflects disparities in resource availability and clinical outcomes. This study compared epidemiological profiles of trauma patients treated at a public versus a private hospital in Salvador, Bahia, Brazil. We retrospectively analyzed 6,472 trauma-related hospitalizations from August 2021 to August 2023. Data were extracted from Hospital Information System/Department of Informatics of the Unified Health System and a private hospital database. Patients admitted under the 10th revision of the International Classification of Diseases, categories S00-T88, were included, excluding burns and orthopedic injuries. A χ2 test assessed associations between trauma mechanisms and hospitals. Among the 6,472 cases, 6,342 occurred in the public hospital and 130 in the private hospital. In the public hospital, males accounted for 82.1% of the cases, and the leading causes were motorcycle crashes (21.7%) and gunshot wounds (16.2%). At the private hospital 58.4% of patients were males, with falls (50.8%) predominating among older adults. Violence-related injuries predominated in the public hospital, while falls predominated in the private hospital. This study revealed distinct trauma patterns in the public versus the private hospital in one Brazilian city. The public hospital treated younger male victims of violence, while the private hospital treated older patients with falls. These findings underscore the need for policies addressing trauma care disparities.
Introduction: While global burden is underappreciated, traumatic wounds account for 23 million annual emergency department visits in the United States, accounting for trillions in medical costs and work and quality of life loss. We hypothesized that the use of intact fish skin grafts (IFSGs) would result in faster time to obtain a graftable wound bed compared to a synthetic matrix (SM). Methods: This retrospective analysis of patients with full-thickness acute traumatic wound was conducted on a matched sample of patients receiving IFSG versus SM. We hypothesized that there would be at least a 10-day difference between the two treatments. Two surgeons reviewed electronic charts for primary outcomes. Incomplete charts were excluded. For sensitivity analysis, both simple linear regression and generalized linear mixed models were utilized to adjust the primary outcome to potential confounders. Results: Data were reviewed for 80 patients. The final cohort included 38 patients [IFSG (n = 12) and SM (n = 26)]. Demographics were not different between groups. The mean age was 42.4 ± 20.7 years, with 62.2% being male and equal proportions having burns treated vs. another traumatic wound. The most common site was the lower extremity. All IFSG patients had negative pressure wound therapy (NPWT) placed at the time of implantation vs. 50% of SM (p = 0.001). The SM group had a larger TBSA (p < 0.001) and wound size (p = 0.001). Differences were subsequently used to adjust primary outcomes via regression. Patients with IFSG had faster time to a graftable wound bed compared to SM (mean ± SD: 13.9 ± 5.3 vs. 29.1 ± 10.3, p < 0.001). Neither wound size, burn severity, presence of infection, nor use of NPWT significantly altered the inference. Conclusions: In this paired sample, the use of IFSG as a dermal template for full-thickness traumatic injuries was associated with faster time to obtain a graftable wound bed compared to an SM. However, regression analysis alone is not enough to conclude that the same difference would exist in a prospectively controlled experiment, which should be performed.
The risk of venous thromboembolism (VTE) in subsets of the most severely injured patients can approach 30%. Statins have anti-inflammatory properties and exert beneficial effects on the endothelium, but few previous studies have evaluated their effects on VTE in risk-stratified groups. We hypothesized that statin use was associated with lower VTE in high-risk trauma patients. All patients admitted to the trauma intensive care unit (ICU) from 1/2024 to 11/2024 at a single level 1 trauma center were risk-stratified using the Greenfield Risk Assessment Profile (RAP). Nontrauma patients and burn patients were excluded. Outcomes were compared between patients with and without VTE, defined by deep vein thrombosis or pulmonary embolism. Univariate analyses and multivariate logistic regression evaluated the association between statin use and VTE. Statistical significance was assessed at p≤0.05. In 509 patients (age 52±22 y, 71% male, 18% penetrating injury), the average RAP score was 10±5, the overall VTE rate was 17%, and mortality was 5%. Compared with statin nonusers, statin users (n=100) were older, with more blunt injury, similar RAP scores and thromboprophylaxis use, but had a significantly lower VTE rate (8 vs. 19%, P=0.007). After RAP-based stratification, the high-risk group (RAP≥10) had a VTE rate of 28%. After controlling for confounding variables with multivariate logistic regression, statin use was independently associated with decreased VTE with an odds ratio of 0.209 (95% CI: 0.065-0.670, P=0.008). Severely injured patients have high rates of VTE despite thromboprophylaxis;, however, the incidence of VTE was significantly lower among statin users. In the highest risk patients, statin use was independently associated with decreased odds of VTE. Because of their pleiotropic effects, including anti-inflammatory and endothelial protective properties, statins may be an important adjunctive therapy in VTE chemoprophylaxis. (J Trauma Acute Care Surg. 2026;00: 000-000 Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.). Level III, therapeutic/care management.
BackgroundFollowing Hurricane Helene, our rural level 1 trauma center in Eastern Tennessee managed a sharp rise in tree-related injuries. We sought to determine whether post-disaster patients required greater inpatient resources than patients injured under baseline conditions, independent of presenting injury severity.MethodsThis IRB-approved (#0125.12) retrospective study identified adult patients with tree-related injuries from our trauma registry using ICD-10 E codes. We compared a pre-Helene cohort (January 2018-September 26, 2024; n = 176) to a post-Helene cohort (September 27-December 2024; n = 25). Outcomes included ICU admission, ICU length of stay, mechanical ventilation, operative intervention, and discharge disposition.ResultsPost-Helene patients required significantly more intensive care despite presenting with similar injury severity scores and initial physiologic parameters. Mechanical ventilation was needed in 24% of post-Helene patients vs 9.1% pre-Helene (OR 3.16, 95% CI: 1.10-9.04, P = 0.025). ICU length of stay was longer post-Helene (6 days [IQR 3-16] vs 3 days [IQR 2-7], P = 0.036). Discharge to extended care facilities was more frequent (36% vs 15.9%, OR 2.97, 95% CI: 1.20-7.39, P = 0.015). Post-Helene patients also carried a substantially higher burden of cardiopulmonary and renal comorbidities.ConclusionIn a rural disaster setting, tree-related trauma patients placed greater demands on critical care, ventilator, and post-acute resources than their initial presentations predicted. Hospital preparedness plans for rural level 1 trauma centers must account for this gap between triage acuity and downstream resource utilization.
Access block is defined as a delay in access to inpatient beds for patients from the Emergency Department (ED). It is a key contributor to ED overcrowding and is associated with worse patient outcomes. This study aimed to quantify access block within Chris Hani Baragwanath Academic Hospital's Trauma Emergency Unit (TEU) and identify associated factors. A retrospective review was conducted of all consecutive patients presenting to the TEU resuscitation room from January 1 to December 31, 2022. Patients aged <14 years (<10 for burns) and those managed by other services were excluded. Data on demographics, clinical characteristics, resuscitation length-of-stay, interventions, and disposition were analysed. Access block was defined as a >8 h delay for the purposes of this study. Univariable analyses were performed to identify associations with access block. During the study period, 2270 patients were admitted from the resuscitation room to the ward without first requiring the operating theatre, of whom 2091 had a recorded length-of-stay. Access block affected 61.3%. In unadjusted analysis, factors significantly associated with access block included a requirement for CT imaging (OR 4.17), intensive care unit (ICU) admission (OR 3.69), mechanical ventilation (OR 2.10), blunt mechanisms of injury (OR 2.19), presenting at night (OR 1.85), and an arrival shock index ≥1 (OR 1.32). Conversely, presenting with penetrating trauma (OR 0.61), burns (OR 0.50), and undergoing intercostal catheter insertion (OR 0.53) were associated with significantly lower odds of access block. Time-to-CT was significantly longer in patients with access block (366 vs 165 min; P < 0.01). Patients requiring mechanical ventilation had significantly longer length-of-stay (834 vs 631 min; P < 0.01), even once time-to-CT was accounted for. Most admitted patients were affected by access block. Associated factors included CT imaging, ICU admission, mechanical ventilation, and presentation at night. This corroborates the international consensus that whole-of-system solutions are necessary to remedy it.
BackgroundMost patients with pneumomediastinum from blunt injury have a self-limited condition and additional testing is no longer recommended given the low incidence in underlying aerodigestive injury. This study characterizes practice patterns in evaluating patients with diagnosed pneumomediastinum.MethodsData from a level 1 trauma center were analyzed from 2013 to 2022 for blunt trauma patients with pneumomediastinum diagnosed by imaging of the chest. Outcomes analyzed included mechanism of injury, diagnostic studies, procedures, and presence of an aerodigestive injury.Results351 patients were included; 71% were male; 35% were transfers. The most common mechanisms of injury were MVC (54%), fall (11%), and motorcycle/ATV accident (11%). 227 patients had pneumomediastinum and pneumothorax on CT (65%). Of the 124 with isolated pneumomediastinum on CT scan (35%), 96 had reliable mental status (GCS ≥13) and all were asymptomatic of an aerodigestive injury. 9 (9.4%) underwent endoscopy or esophagram with no injuries identified. No patients were diagnosed with an esophageal injury. Seven patients (2%) were diagnosed with tracheal injury; all presented with physical exam findings (subcutaneous emphysema, respiratory failure, and/or dysphonia), none with isolated pneumomediastinum. 12 patients (9.6%) were transferred with isolated pneumomediastinum. Of the transfer population, twenty did not meet criteria for trauma activation upon arrival (16%) and five were discharged from the emergency department (4%).ConclusionAerodigestive injuries amongst patients with radiographically diagnosed pneumomediastinum are rare. However, many asymptomatic patients are assessed with additional diagnostic tests and are potentially overtriaged with transfers to higher levels of care.
Computed Tomography (CT) with intravenous (IV) contrast is critical to the evaluation of the trauma patient. A pandemic-related lockdown occurred in Spring 2022 in the city where iohexol iodinated contrast media) is manufactured, resulting in a global shortage. We explored the potential impact of this shortage on contrast utilization and patient outcomes. A retrospective study was performed of all trauma patients who underwent CT between January and December 2022 at a level I trauma center. Pre-contrast conservation (PRE) period was defined as January to April 2022, and post-conservation (POST) as May to December 2022. Demographics, utilization rates (bolus/patient) and outcomes were evaluated. Chi-square tests were performed for categorical variables and Mann-Whitney U tests for continuous variables. Statistical significance was set at p < 0.05. 1,097 patients were included; 509 in the pre-shortage period, 588 post-shortage. 857 CTs with contrast (1.68 contrast bolus/patient) were performed pre-conservation and 979 post-conservation (1.66 contrast bolus/patient) (p = 0.04). Maximum Abbreviated Injury Scale (AIS) head, head/neck, and extremity were higher post-shortage (p < 0.05); however, mortality was higher in the pre-conservation group (p < 0.0012). There were 9 cases of Acute Kidney Injury (AKI, 8 PRE, 1 POST), 22 delayed diagnoses (14 PRE, 8 POST) and 2 missed injuries (PRE 2, POST 0). Despite a nationwide IV contrast shortage and volume of contrast utilization per patient, we did not observe an increase in delayed diagnoses, missed injuries or AKI although these events remain small with no clear adverse signal. This may reflect the proactive institutional measures deployed to decrease nonurgent contrast use in the inpatient and outpatient settings in order to conserve contrast for more emergent settings. Based on the limited data set and truncated pre-shortage periods we were not able to reach any meaningful conclusions regarding quality of care and impact on outcomes. Next steps may include multi-center analysis to determine the larger clinical impact of this shortage.
We present a review of a pro bono legal service provided to patients treated at a regional burns centre in the United Kingdom for the period between October 2012 and October 2019. A solicitor, supported by a paralegal, was available to give pro bono advice to any patient attending the burns service. The legal team provided assistance to patients and their relatives with advice pertaining to their personal and financial affairs as impacted by the injury. This was provided independently from, but in addition to, existing support from the hospital legal and ethical departments. The pro bono legal service has advised on 108 patient cases since this service began in October 2012 and has provided more than 2100 h of solicitors' time. 777 h were spent on non-compensation advice given on welfare benefits and insurance. Advice on welfare and/or financial matters was requested by all patients, and although potential claims for compensation against a third party were found in 83 cases, of these, the law firm operating the legal service was known to have been instructed to pursue recourse in only 16 cases. However, of the 16 cases instructed to make a compensation claim so far, 6 cases have settled, recovering a total of over £ 3.7 million. This review shows a likely benefit to patients from pro bono legal advice available in a burns unit setting. It also showed the significant financial gain to the government and potentially the NHS when a compensation claim was made by a patient.
Burns are one of the most devastating traumatic injuries, and in cases of advanced burns, patients require urgent and specialized care to minimize mortality. Studies have shown that a variety of herbal medicines and nanoparticles can be used to treat burn wounds. Among them mixture of Eisenia fetida oil, valerian, and zinc oxide (ZnO) nanoparticles can be a good choice due to their healing properties. This study aimed to synthesize an ointment based on Eisenia fetida oil, Valeriana officinalis, and zinc oxide to investigate its effect on skin wound healing. The hemocompatibility and biocompatibility of the designed ointment were evaluated using blood clotting index (BCI), hemolysis test, and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) test. The antibacterial effects of the designed ointment were evaluated using minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and time-kill tests. Finally, the healing ability of the designed ointment was evaluated in a rat model by creating a 3 × 3 cm burn wound. Wound healing was evaluated after 14 days by hematoxylin-eosin (H&E) and Verhoeff-Van Gieson (VVG) staining. The results showed that the addition of Valeriana officinalis and zinc oxide to Eisenia fetida oil improved hemocompatibility, biocompatibility, improved cell migration, and improved antibacterial properties. Additionally, the results of H&E and VVG staining demonstrated the good efficacy of the designed ointment in increasing epidermal thickness, promoting angiogenesis, and enhancing collagen and elastin fibers. These results indicate the potential of the designed ointment as a promising tool for skin wound healing and clinical trials.
To analyze treatment outcomes in children with chemical burns caused by various agents depending on depth of lesion over the past 5 years. There were 279 patients aged 0-18 years with complaints of burn wounds sustained from contact with various chemical reagents over last 5 years. The article describes the features of local treatment for superficial (grade I-II) burns with modern wound dressings and surgical strategies for wound repair in patients with deep chemical burns. Effectiveness of treatment strategy is demonstrated by clinical examples. Анализ результатов лечения детей с химическими ожогами, вызванными различными повреждающими агентами, в зависимости от глубины поражения кожи и подлежащих тканей за последние 5 лет. За описываемый период в клинику обращались 279 пациентов в возрасте от 0 до 18 лет с жалобами на наличие ожоговых ран, полученных при контакте с различными химическими реагентами. Описаны особенности местной консервативной терапии при поверхностных ожогах I—II степени с использованием современных раневых покрытий, тактика хирургического лечения по восстановлению раневых дефектов у пострадавших с глубокими химическими ожогами. Эффективность выбранной тактики ведения детей с химическими ожогами кожи доказана приведенными клиническими примерами.
This study identifies and characterises changes over time in depression and post-traumatic stress disorder (PTSD) symptoms in hospitalised adult burn survivors to inform mental-health treatment and management. 274 adults admitted to a tertiary burns centre in Queensland, Australia between 01 Oct 2015 and 31 Dec 2017 were recruited. Personal, environmental, injury and treatment data were collected at baseline, 3, 6 and 12 months post-burn, in addition to depression symptoms [Patient Health Questionaire-9 (PHQ-9)] and PTSD symptoms [PTSD Checklist-Civilian (PCL-C)]. Trajectory modelling identified distinct groups for depression and PTSD separately, based on changes in symptom severity over 12-months. Three distinct trajectory groups were identified for PHQ-9: 'Always Mild', 'Always Moderate' and 'Moderately-Severe to Moderate', and for PCL-C: 'Always Low', 'Always Moderate' and 'High to Moderate'. Pre-injury mental health diagnoses and intentional injuries were observed more frequently in both the PHQ-9 'Moderately-Severe to Moderate' and the PCL-C 'High to Moderate' groups. Symptoms of depression and PTSD in adult burn survivors decrease over the first 12 months post-discharge. However, the magnitude of change, and factors associated with change, vary among identified participant subgroups, and must be considered when planning treatment.
The objective of this study was to determine whether protocolized triage using the Rib Injury Guidelines (RIG) can safely reduce intensive care unit (ICU) admissions and improve institutional resource utilization in a rural, Appalachian, level 1 trauma center. This was a single-center retrospective cohort study that included a total of 1148 adult patients who presented to the institution with radiographically confirmed rib fracture(s) over the course of 2 years (557 pre-RIG, 591 post-RIG). Prior to RIG implementation, triage decisions were made at the discretion of the attending provider using a protocol based on three factors: ≥3 rib fractures, age >65, and incentive spirometry (IS) <1L or <15 mL/kg ideal body weight (IBW). Patients in the post-RIG group were of higher acuity with a significantly higher percentage having ≥3 rib fractures (53.3% vs 45.2%, P = 0.006) and thoracic injuries as their highest Abbreviated Injury Scale (AIS) score (56.0% vs 24.6%, P < 0.001). Despite this higher acuity, implementation of RIG was associated with a 28.9% decrease in ICU admissions from the ED (OR 0.711, 95% CI: 0.563-0.899, P = 0.004) without a corresponding increase in floor-to-ICU transfers (P = 0.166), unplanned intubations (P = 0.803), morbidity, or mortality (P = 0.364). Additionally, it reduced the hospital charges incurred by each patient. These findings suggest that protocolized triage using RIG is feasible and safe in rural settings, improving resource utilization without compromising patient outcomes.
The 21st Chinese Conference on Burns and Wound Repair was successfully held in the historic city of Xi'an from May 28th to 30th, 2026, bringing together over 800 participants from across the country for this academic event. The conference featured one main venue and six parallel thematic sub-forums and invited over 300 renowned experts and scholars from China and abroad to engage in in-depth academic exchanges and intellectual dialogues over three days around key topics such as severe burn care, acute and chronic wound management, scar prevention and treatment, rehabilitation and nursing, and youth innovation. The conference showcased the latest breakthroughs and cutting-edge achievements in burn medicine and wound repair fields in China, enhanced the capabilities and standards in critical injury management, complex wound repair, and comprehensive scar prevention and treatment. The conference thereby effectively promoted the high-quality development of burn care and wound repair in China. 2026年5月28—30日，第二十一届烧伤与创面修复大会于古都西安顺利召开，汇聚了全国800余名代表共襄学术盛会。大会设立1个主会场与6个专题分会场，特邀国内外300余名知名专家学者，围绕危重烧伤救治、急慢性创面修复、瘢痕防治、康复护理及青年创新等核心议题，展开为期3天的深度交流与思想碰撞。会议展示了我国烧伤医学与创面修复领域的最新突破性研究成果，提升了我国危重伤救治、复杂创面修复及瘢痕综合防治能力与水平，推动我国烧伤与创面修复事业的高质量发展。.
Personality change is a debilitating consequence of traumatic brain injury (TBI), yet its prevalence, characteristics, and treatment remain poorly understood. We completed a pre-registered (CRD42023440990) systematic review and meta-analysis searching four databases (MEDLINE, PsycINFO, EMBASE and CINAHL) for primary studies assessing personality change after TBI. We synthesized conceptualization, prevalence, longitudinal outcome, lesion location, and treatment. Prevalence was estimated using a random effect meta-analysis using the Paule-Mandel estimator, with subgroup, meta-regression and robustness analyses. A total of 101 studies were included in this review, seventeen of which were suitable for meta-analysis. Personality change was defined inconsistently although common symptoms involved the emergence or increase of affective, behavioral, and social disturbances, including irritability, depression, emotional instability, anger outbursts, social withdrawal, anxiety, impulsivity, restlessness, aberrant motor behaviors, and aggression. The prevalence of secondary personality disorder was estimated as 29.1% (CIs 22.5% - 36.2%) and prevalence of broad personality change was 68.1% (CIs 53.4% - 81.2%). Robustness analyses showed that the estimate for broad personality change should be treated with caution as it was unstable when adjusted for risk of bias and potential publication bias. Follow-up studies, although of varying quality, consistently showed personality change remained stable over long follow-up periods. The relationship between personality change and specific lesion locations in TBI remains unclear, likely due to the poor methodological quality of studies examining this association. Perhaps most concerning, there is limited evidence and very few systematic studies addressing treatment. Personality change is a common and persistent consequence of TBI. Varying definitions, and the lack of high-quality lesion mapping studies and systematic investigations into treatment highlights critical gaps in understanding and management.
Objective: To investigate the effects and mechanisms of cerium-myricetin nanosystem (Ce-MYR) on wound healing in rats with full-thickness burns. Methods: This study was an experimental study with a grouped design and repeated measurement design. Ce-MYR was prepared by coordination self-assembly and characterized. Mouse RAW264.7 cells were divided into control group cultured normally, hydrogen peroxide group treated with hydrogen peroxide, and low Ce-MYR group, medium Ce-MYR group, and high Ce-MYR group which were first exposed to hydrogen peroxide and subsequently treated with Ce-MYR at final mass concentrations of 5, 10, and 20 μg/mL, respectively. After 24 h of culture, intracellular reactive oxygen species (ROS) levels were detected using the fluorescent probe method. Mouse bone marrow-derived macrophages (BMDMs) were divided into control group cultured normally, lipopolysaccharide (LPS) group treated with LPS, and Ce-MYR group treated with LPS combined with Ce-MYR. After 24 h of culture, the percentages of CD86- and CD206-positive areas in cells were calculated after immunofluorescence staining. Additional mouse BMDMs were divided into the LPS group and the Ce-MYR group, as described above. After 24 h of culture, the protein expressions of heme oxygenase-1 (HO-1), arginase-1 (Arg-1), inducible nitric oxide synthase (iNOS), and NOD-like receptor family pyrin domain-containing protein 3 (NLRP3) in cells were detected by Western blotting. The sample size in all the above experiments was 4. Ten 6-week-old male Sprague-Dawley rats were used to establish four full-thickness burn wounds on the back of each rat, which were divided into phosphate-buffered saline (PBS) group and Ce-MYR group according to the random number table method, with 5 rats in each group. PBS or Ce-MYR was subcutaneously injected at the wound margin at post-injury days 0 (immediately), 3, and 6, respectively. The percentages of residual wound area were calculated at post-injury days 3, 7, 14, and 21. At post-injury day 21, the wound tissue of rats was collected and the number of CD31-positive blood vessels was counted after immunohistochemical staining, the percentages of CD86- and CD206-positive areas were calculated after immunofluorescence staining, and the levels of interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay. Results: After 24 h of culture, the ROS level in RAW264.7 cells in hydrogen peroxide group was significantly higher than that in control group (P<0.05); the ROS level in RAW264.7 cells in medium Ce-MYR group was significantly lower than that in low Ce-MYR group (P<0.05) and significantly higher than that in high Ce-MYR group (P<0.05). After 24 h of culture, the percentage of CD86-positive area in BMDMs in Ce-MYR group was significantly lower than that in LPS group (P<0.05) and significantly higher than that in control group (P<0.05); the percentage of CD206-positive area in BMDMs in Ce-MYR group was significantly higher than that in control group and LPS group (with P values both <0.05). After 24 h of culture, compared with those in LPS group, the protein expressions of HO-1 and Arg-1 in BMDMs in Ce-MYR group were significantly increased (P<0.05), whereas the protein expressions of iNOS and NLRP3 were significantly decreased (P<0.05). At post-injury days 3, 7, 14, and 21, the percentages of residual wound area in rats in Ce-MYR group were (87.1±2.4)%, (65.1±2.2)%, (16.6±1.9)%, and (0.5±0.4)%, respectively, which were significantly lower than (101.5±3.5)%, (79.9±3.2)%, (36.2±3.9)%, and (14.5±1.9)% in PBS group (with t values of 7.604, 8.478, 10.193, and 16.166, respectively, P<0.05). At post-injury day 21, compared with those in PBS group, the number of CD31-positive blood vessels in wound tissue of rats in Ce-MYR group was significantly increased (t=3.395, P<0.05), the percentage of CD86-positive area was significantly decreased (t=4.474, P<0.05), the percentage of CD206-positive area was significantly increased (t=4.713, P<0.05), and the levels of IL-1β, IL-6, and TNF-α were significantly decreased (with t values of 3.999, 5.040, and 6.023, respectively, P<0.05). Conclusions: Ce-MYR may promote wound healing by reducing ROS levels, enhancing HO-1-related antioxidant responses in macrophages, thereby facilitating macrophage polarization from the M1 phenotype toward the M2 phenotype and improving oxidative stress and inflammatory imbalance in rats with full-thickness burn wounds. 目的： 探讨铈-杨梅素纳米体系（Ce-MYR）对Ⅲ度烧伤大鼠创面愈合的作用及其机制。 方法： 该研究为成组设计与重复测量设计实验研究。采用配位自组装法制备Ce-MYR并表征。取小鼠RAW264.7细胞，分为常规培养的对照组、用过氧化氢处理的过氧化氢组，以及用过氧化氢处理后加入终质量浓度分别为5、10、20 μg/mL Ce-MYR处理的低Ce-MYR组、中Ce-MYR组、高Ce-MYR组，培养24 h后，采用荧光探针法检测细胞内活性氧水平。取小鼠骨髓来源巨噬细胞（BMDM），分为常规培养的对照组、用内毒素/脂多糖（LPS）处理的LPS组及用LPS联合Ce-MYR处理的Ce-MYR组，培养24 h后，行免疫荧光染色后计算细胞中CD86和CD206阳性面积百分比。另取小鼠BMDM，分为同前处理的LPS组和Ce-MYR组，培养24 h后，采用蛋白质印迹法检测细胞中血红素加氧酶1（HO-1）、精氨酸酶1（Arg-1）、诱导型一氧化氮合酶（iNOS）和NOD样受体热蛋白结构域相关蛋白3（NLRP3）的蛋白表达。上述实验样本数均为4。取10只6周龄雄性SD大鼠，于每只大鼠背部建立4个Ⅲ度烧伤创面，按随机数字表法将大鼠分为磷酸盐缓冲液（PBS）组和Ce-MYR组（每组5只），于伤后0（即刻）、3、6 d分别在创缘皮下注射PBS或Ce-MYR，计算伤后3、7、14、21 d剩余创面面积百分比；伤后21 d，取大鼠创面组织，行免疫组织化学染色后计数CD31阳性血管数，行免疫荧光染色后计算CD86和CD206阳性面积百分比，采用酶联免疫吸附测定法检测白细胞介素6（IL-6）、IL-1β、肿瘤坏死因子α（TNF-α）的水平。 结果： 培养24 h后，过氧化氢组RAW264.7细胞内活性氧水平明显高于对照组（P<0.05）；中Ce-MYR组RAW264.7细胞内活性氧水平明显低于低Ce-MYR组（P<0.05），明显高于高Ce-MYR组（P<0.05）。培养24 h后，Ce-MYR组BMDM中CD86阳性面积百分比明显低于LPS组（P<0.05），明显高于对照组（P<0.05）；Ce-MYR组BMDM中CD206阳性面积百分比明显高于对照组和LPS组（P值均<0.05）。培养24 h后，与LPS组比较，Ce-MYR组BMDM中HO-1和Arg-1的蛋白表达均明显增加（P<0.05），iNOS和NLRP3的蛋白表达均明显减少（P<0.05）。伤后3、7、14、21 d，Ce-MYR组大鼠剩余创面面积百分比分别为（87.1±2.4）%、（65.1±2.2）%、（16.6±1.9）%、（0.5±0.4）%，均明显低于PBS组的（101.5±3.5）%、（79.9±3.2）%、（36.2±3.9）%、（14.5±1.9）%（t值分别为7.604、8.478、10.193、16.166，P<0.05）。伤后21 d，与PBS组比较，Ce-MYR组大鼠创面组织中CD31阳性血管数明显增加（t=3.395，P<0.05），CD86阳性面积百分比明显降低（t=4.474，P<0.05），CD206阳性面积百分比明显升高（t=4.713，P<0.05），IL-1β、IL-6和TNF-α的水平均明显降低（t值分别为3.999、5.040、6.023，P<0.05）。 结论： Ce-MYR可通过降低巨噬细胞内活性氧水平、增强HO-1相关抗氧化应答，促进巨噬细胞由M1型向M2型极化，改善Ⅲ度烧伤大鼠创面氧化应激与炎症失衡状态，从而促进创面愈合。.
Since the onset of the 2023 Israel-Gaza war, the healthcare system in the Gaza Strip has nearly collapsed. More than 70,937 casualties and 171,192 injuries have been reported, yet limited data exist on injury types and outcomes. Critical care services are essential during conflicts. This study aimed to determine causes of intensive care unit (ICU) admissions, associated injuries, complications, and outcomes in the Gaza Strip. We conducted a prospective cohort study of all adult and pediatric patients admitted to the ICUs at European Gaza Hospital and Shuhada Al-Aqsa Hospital between May 29 and June 30, 2024. Outcomes of interest were causes of admission, survival, types of complications, and length of stay. A total of 115 patients were admitted. Median age was 27 years (interquartile range 18-38), including 30 pediatric patients (26%). Thirty-five patients were female (30%). Trauma with or without burns accounted for 75 admissions (65%), while 27 (23.5%) had medical causes. Among trauma patients, 56 (75%) were from explosive injuries; traumatic brain injury was most common (30/75, 40%), including 10 of 21 pediatric trauma patients (47.6%). During ICU stay, 12 patients developed sepsis (10.6%), 10 developed septic shock (8.8%), and 12 developed multiorgan dysfunction (10.6%). Of 112 patients with known disposition, 64 were discharged and 48 died (43%). Median ICU survival was 6 days (95% confidence interval 5-17), and 17 days for pediatric patients (95% confidence interval 5-not calculable). Severe traumatic brain injury (33%) was the leading cause of death, followed by septic shock (22%). The high burden of trauma, complications, and mortality reflects the critical collapse of Gaza's healthcare system. Women and children represented a substantial proportion of ICU patients, highlighting civilian vulnerability. Urgent international medical intervention, humanitarian support, and a permanent ceasefire are essential to prevent continued loss of life.
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