Blunt hepatic trauma is frequently seen, particularly as a result of traffic accidents. Given that surgical therapy may have high rates of morbidity and mortality, a selected group of patients may can benefit from conservative management. We herein present, a group of patients with blunt hepatic trauma who were managed without any invasive diagnostic tools and / or surgical intervention. Nineteen hemodynamically stable patients (9 males, 10 females; mean age 46,6; range 19-73 years) with blunt hepatic trauma were included in the study. Vital signs, hemodynamic parameters, liver function tests, need for transfusion, hospital stay and results of radiological tests were recorded as well as demographic characteristics. Classification of injury was done according to the American Association for the Surgery of Trauma's Organ Injury Scaling System. Nineteen patients had radiologically-proven liver injury. Nine patients had grade I injury, five had grade II, two had grade II and three had grade IV injuries. Twelve patients required blood transfusions. Fourteen patients had mild elevation of transaminases while the remaining five were completely normal. Mean hospital stay was 7.6 days. Blunt trauma was associated with a large abdominal wall hernia in one patient; the defect was repaired laparoscopically three months later. No patient underwent surgery due to the failure of conservative management and there was no death. For blunt hepatic trauma patients, non-operative management may be the initial therapy if haemodynamic stability can be maintained. The decision for surgical intervention should be given according to the presence of associated intraabdominal injuries. Liver injury score of patients is not as important as the hemodynamic status for determining conservative management.
The aim of this study was to present characteristics of internationally published articles originating from Turkish Emergency Medicine (EM) departments over the last 15 years. The PubMed database was searched for all articles published from 1995 to 2010 that originated from Turkish EM departments. RESULTS A total of 514 articles were included. Of all articles, 77% (n=396) were published in the last five years. Publications were detected to increase at a rate of 6.2 articles per year. 58.7% (n=302) of the articles were published in non-EM journals. Advances in Therapy in the non-EM group, with 27 articles, and the Turkish Journal of Trauma & Emergency Surgery in the EM group, with 48 articles, were the preferred journals. The most popular subjects were toxicology, at 26% (n=134), followed by trauma, at 16% (n=86). 7.7% (n=40) of all articles were animal studies and 6% (n=31) were randomized controlled trials. Significant publication growth was detected related with the development of EM in Turkey. The preference for non- EM journals, toxicology as the most popular subject and the effect of university hospitals were the interesting results of this study. The low number of multicenter, randomized controlled trials and of published articles in high impact factor journals have led us to consider the importance of publication quality, which requires additional effort.
Deaths due to gunshot wounds (GSWs) have become an increasingly important public health problem in Türkiye and abroad. The aim of this study was to conduct a bibliometric analysis of articles about GSW. Within the scope of the research, the Web of Science database was examined with the bibliometrix program. GSW, gunshot injuries, gunshot injury, firearm wound, firearm injuries, and firearm injury were used as keywords. As a result of the analysis, 1236 articles published in 479 different journals between 1980 and 2022 were reached. The an-nual growth rate of the articles was 6.69% and the average citation per article was 9.78. The United States of America (USA) (n=562, 45.4%), Türkiye (n=102, 8.25%), and India (n=42, 3.4%) were the top three countries with the highest publication performance. The top three most influential researchers are Elias Degiannis and Roger Saadia from South Africa and C. William Schwab from the USA. The most influential researcher of Turkish origin was Ersin Erdogan. 'Journal of Trauma-Injury Infection and Critical Care,' 'Ameri-can Surgeon,' and 'Injury-International Journal of the Care of the Injured' are the top three most influential journals in terms of the number of publications and citations. 'Turkish Journal of Trauma and Emergency Surgery' from Türkiye is the eighth most influential journal. The most influential study in terms of citations was found to be the study titled 'Firearm injuries in the United States' by Katherine A Fowler, published in Prev Med in 2015. As a result of the research, useful information has been revealed for researchers working on GSW. Being the first comprehensive bibliometric study in the field of GSW makes this research unique.
Penetrating cardiac injuries are a dramatic and lethal form of trauma. Most of these patients reach the hospital already dead or in severe shock. The prognosis is determined by early diagnosis and operation. In this study, we discuss the effects of the etiology of trauma, the state of presentation in the emergency department, and the treatment approaches on the morbidity and mortality in penetrating cardiac trauma treated in our clinic. Fifty-two patients treated due to penetrating cardiac injury were investigated retrospectively. Demographic characteristics, etiology of the injury, arrival time at the hospital, physical examination findings in the emergency room, diagnostic methods used, and surgical methods applied were determined along with the results. The male to female ratio was 48:4, and mean age was 27.86+/-13.73. The etiology was stab injury in 46, gun shot injury in four and iatrogenic trauma in two patients. Surgery was applied in emergency condition for all cases. Cardiac injury was repaired using primary repair technique. Hospital mortality was determined as 15.4% (8 patients). Penetrating cardiac injuries lead to shock in a very short period of time because of bleeding and/or pericardial tamponade. Early diagnosis and prompt thoracotomy are the fundamental factors affecting patient outcome after penetrating cardiac injury.
Lower gastrointestinal bleeding is a commun clinical entity. Although colonoscopic examination is the first choice for diagnosis, it may not be enough to reveal the cause of bleeding in all subjects. Eight patients who had massive lower gastrointestinal bleeding having normal colonoscopic findings were retrospectively evaluated at the Department of Trauma and Emergency Surgery, Istanbul University, Faculty of Medicine There were 5 male and 3 female patients with mean age of 51 (28 to 82). Patients received a mean of 13 U (range 2 to 23) with transfused erythrocyte concentrates. Four patients had found to be normal during angiographic, scintigraphy or enterocylytic examinations. Angiography was diagnostic in 4 patients, and identified bleeding from ileocolic pseudoaneurisms (n= 2) branches of jejunal artery (n=2). Embolization procedure were performed in these 4 patients and 3 of them developed intestinal necrosis and underwent surgery. One did not require further treatment. Two of the patients who underwent surgery expired due to sepsis. Patients were hospitalized for a mean of 17 days (range 5 to 37). Despite employment of all diagnostic procedures, the cause of bleeding were not detected in half of patients who had normal colonoscopic findings. If angiographic treatment is necessary, superselective arterial embolization should be performed.
Thoracic traumas constitute an important part of the patients who are being admitted to the emergency units and deaths due to trauma. The aim of this study was to compare our clinical experience and results of the literature. 592 patients with thoracic trauma who were admitted to our clinic between 1996 and 2000 were evaluated retrospectively. 449 patients (75.8%) had blunt and 43 patients (24.2%) had penetrating thorax trauma. There was rib fracture in 448 patients (75.7%), clavicula fracture in 55 (9.2%), scapula fracture in 31 (5.2%) and sternal fracture in 20 (3.4%). In addition, flail chest was detected in 79 cases (13.3%). The most frequent complications were pneumothorax (n: 158; 26.7%), and hemothorax ( n: 119; 20.1% ). Three hundred and thirty - nine patients (57.2%) were treated by tube thoracostomy and 190 by conservative management (32.1%). Surgical treatment was performed in 99 (16.7%) patients. Morbidity was 18.4% ( n: 109 ) and mortality, 6.4% ( n: 38 ). Mean hospital stay time was 13.4 days (2 - 93 days). Thoracic traumas can cause vital organ injuries and impaired cardio-respiratory hemodynamics should be treated immediately.
We evaluated thoracic trauma cases with respect to etiologic causes, other system injuries accompanying to the thoracic trauma, treatment methods and outcomes and the prognostic factors affecting the need for thoracotomy, length of hospital stay, morbidity and mortality in the light of relevant literature data. A retrospective evaluation was performed on 141 patients (102 males (72.3%), 39 females (27.7%); mean age 40; range 8 to 89 years) who were treated for thoracic trauma in our center between July 2003 and December 2005. 117 patients (83%) had blunt and 24 (17%) penetrating thoracic trauma. Isolated thoracic trauma and multisystem trauma were found in 48 (34%) and 93 (66%) patients, respectively. Mean white blood cell count was 12.560+/-5.7 (5-25 x 103 /uL) at admission. The number of patients who met lung injury scale criteria for grade I, grade II, grade III and grade IV were 19 (13.5%), 12 (8.5%), 25 (17.7%) and 13 (9.2%), respectively. Hypotension was determined in 16 patients (11.3%) during admission. With regard to treatment, while symptomatic conservative management was satisfactory in 76 patients (53.9%), tube thoracoscopy and thoracotomy were performed in 59 (41.8%) and 11 (7.8%) patients respectively. The morbidity was seen in 30 patients (21.3%). The mortality rate was 7.8% (n=11). The high white blood cell count, high lung injury scale grade, 3 and more rib fractures and accompanying head injury were determined as the prognostic factors affecting the morbidity and mortality.
We aimed to investigate the affecting factors on the complication ratio in abdominal gunshot wounds. Twenty-one patients with abdominal gunshot wounds were analyzed between February 2002 and May 2005. The effects of the interval between trauma and presentation to the hospital, the number of injured abdominal and extra-abdominal organs, penetrating abdominal trauma index (PATI), and blood transfusion were evaluated. 90.4% of all patients were transported to the hospital and underwent their first evaluation in the first two hours. The complication rate was 7.1% in patients who had <3 injured organs and 71% in the others (p<0.0001). 71.4% of the patients had isolated abdominal trauma, while 28.6% had additional extra-abdominal organ trauma. The complication rate was 7.7% in 13 patients with PATI score <25 and 62.5% in 8 patients with a PATI score ≥25 (p<0.0001). In 10 patients who underwent blood transfusion of ≥3 units, the complication rate was 50% (p<0.0001). In our study, PATI score, multiple blood transfusions and the number of injured intra-abdominal organs were the most important factors affecting the rate of postoperative complications in penetrating abdominal gunshot wounds. We found that the interval between trauma and presentation to the hospital and number of injured extra-abdominal organs did not affect the complication rate.
We compare the network of aggregated journal-journal citation relations provided by the Journal Citation Reports (JCR) 2012 of the Science and Social Science Citation Indexes (SCI and SSCI) with similar data based on Scopus 2012. First, global maps were developed for the two sets separately; sets of documents can then be compared using overlays to both maps. Using fuzzy-string matching and ISSN numbers, we were able to match 10,524 journal names between the two sets; that is, 96.4% of the 10,936 journals contained in JCR or 51.2% of the 20,554 journals covered by Scopus. Network analysis was then pursued on the set of journals shared between the two databases and the two sets of unique journals. Citations among the shared journals are more comprehensively covered in JCR than Scopus, so the network in JCR is denser and more connected than in Scopus. The ranking of shared journals in terms of indegree (that is, numbers of citing journals) or total citations is similar in both databases overall (Spearman's \r{ho} > 0.97), but some individual journals rank very differently. Journals that are unique to Scopus seem to be less important--they are citing shared journals rather than bein
Using Scopus data, we construct a global map of science based on aggregated journal-journal citations from 1996-2012 (N of journals = 20,554). This base map enables users to overlay downloads from Scopus interactively. Using a single year (e.g., 2012), results can be compared with mappings based on the Journal Citation Reports at the Web-of-Science (N = 10,936). The Scopus maps are more detailed at both the local and global levels because of their greater coverage, including, for example, the arts and humanities. The base maps can be interactively overlaid with journal distributions in sets downloaded from Scopus, for example, for the purpose of portfolio analysis. Rao-Stirling diversity can be used as a measure of interdisciplinarity in the sets under study. Maps at the global and the local level, however, can be very different because of the different levels of aggregation involved. Two journals, for example, can both belong to the humanities in the global map, but participate in different specialty structures locally. The base map and interactive tools are available online (with instructions) at http://www.leydesdorff.net/scopus_ovl.
Trauma significantly impacts global health, accounting for over 5 million deaths annually, which is comparable to mortality rates from diseases such as tuberculosis, AIDS, and malaria. In Iran, the financial repercussions of road traffic accidents represent approximately 2% of the nation's Gross National Product each year. Bleeding is the leading cause of mortality in trauma patients within the first 24 hours following an injury, making rapid diagnosis and assessment of severity crucial. Trauma patients require comprehensive scans of all organs, generating a large volume of data. Evaluating CT images for the entire body is time-consuming and requires significant expertise, underscoring the need for efficient time management in diagnosis. Efficient diagnostic processes can significantly reduce treatment costs and decrease the likelihood of secondary complications. In this context, the development of a reliable Decision Support System (DSS) for trauma triage, particularly focused on the abdominal area, is vital. This paper presents a novel method for detecting liver bleeding and lacerations using CT scans, utilising the GAN Pix2Pix translation model. The effectiveness of the method i
Background: AI-driven prediction algorithms have the potential to enhance emergency medicine by enabling rapid and accurate decision-making regarding patient status and potential deterioration. However, the integration of multimodal data, including raw waveform signals, remains underexplored in clinical decision support. Methods: We present a dataset and benchmarking protocol designed to advance multimodal decision support in emergency care. Our models utilize demographics, biometrics, vital signs, laboratory values, and electrocardiogram (ECG) waveforms as inputs to predict both discharge diagnoses and patient deterioration. Results: The diagnostic model achieves area under the receiver operating curve (AUROC) scores above 0.8 for 609 out of 1,428 conditions, covering both cardiac (e.g., myocardial infarction) and non-cardiac (e.g., renal disease, diabetes) diagnoses. The deterioration model attains AUROC scores above 0.8 for 14 out of 15 targets, accurately predicting critical events such as cardiac arrest, mechanical ventilation, ICU admission, and mortality. Conclusions: Our study highlights the positive impact of incorporating raw waveform data into decision support models, im
This study examines the social media uptake of scientific journals on two different platforms - X and WeChat - by comparing the adoption of X among journals indexed in the Science Citation Index-Expanded (SCIE) with the adoption of WeChat among journals indexed in the Chinese Science Citation Database (CSCD). The findings reveal substantial differences in platform adoption and user engagement, shaped by local contexts. While only 22.7% of SCIE journals maintain an X account, 84.4% of CSCD journals have a WeChat official account. Journals in Life Sciences & Biomedicine lead in uptake on both platforms, whereas those in Technology and Physical Sciences show high WeChat uptake but comparatively lower presence on X. User engagement on both platforms is dominated by low-effort interactions rather than more conversational behaviors. Correlation analyses indicate weak-to-moderate relationships between bibliometric indicators and social media metrics, confirming that online engagement reflects a distinct dimension of journal impact, whether on an international or a local platform. These findings underscore the need for broader social media metric frameworks that incorporate locally dom
Using "Analyze Results" at the Web of Science, one can directly generate overlays onto global journal maps of science. The maps are based on the 10,000+ journals contained in the Journal Citation Reports (JCR) of the Science and Social Science Citation Indices (2011). The disciplinary diversity of the retrieval is measured in terms of Rao-Stirling's "quadratic entropy." Since this indicator of interdisciplinarity is normalized between zero and one, the interdisciplinarity can be compared among document sets and across years, cited or citing. The colors used for the overlays are based on Blondel et al.'s (2008) community-finding algorithms operating on the relations journals included in JCRs. The results can be exported from VOSViewer with different options such as proportional labels, heat maps, or cluster density maps. The maps can also be web-started and/or animated (e.g., using PowerPoint). The "citing" dimension of the aggregated journal-journal citation matrix was found to provide a more comprehensive description than the matrix based on the cited archive. The relations between local and global maps and their different functions in studying the sciences in terms of journal lit
Rankings of scholarly journals based on citation data are often met with skepticism by the scientific community. Part of the skepticism is due to disparity between the common perception of journals' prestige and their ranking based on citation counts. A more serious concern is the inappropriate use of journal rankings to evaluate the scientific influence of authors. This paper focuses on analysis of the table of cross-citations among a selection of Statistics journals. Data are collected from the Web of Science database published by Thomson Reuters. Our results suggest that modelling the exchange of citations between journals is useful to highlight the most prestigious journals, but also that journal citation data are characterized by considerable heterogeneity, which needs to be properly summarized. Inferential conclusions require care in order to avoid potential over-interpretation of insignificant differences between journal ratings. Comparison with published ratings of institutions from the UK's Research Assessment Exercise shows strong correlation at aggregate level between assessed research quality and journal citation `export scores' within the discipline of Statistics.
Accurate detection and localization of traumatic injuries in abdominal CT remain challenging because voxel-level annotations are limited and expensive to obtain. We present a label-efficient framework for 3D abdominal trauma detection that combines self-supervised pretraining with semi-supervised transformer-based detection. First, we use Masked Image Modeling (MIM) on 1098 CT volumes to pretrain a 3D U-Net encoder for anatomical representation learning. Next, we adapt V-DETR to dense volumetric CT through a feature adapter that converts the encoder feature grid into a compact token sequence for transformer decoding. The pretrained encoder is then integrated with V-DETR and 3D Vertex Relative Position Encoding (3D V-RPE) to improve the localization of irregularly shaped injuries. Finally, semi-supervised teacher-student consistency regularization leverages 2,000 additional unlabeled volumes during detector training. To the best of our knowledge, this is the first application of a 3D DETR-style detector to the RSNA abdominal trauma detection task. On this benchmark, the proposed method achieves 31.33% test mAP@0.50 using only 78 labeled training volumes, corresponding to a 1.53x imp
A number of journal classification systems have been developed in bibliometrics since the launch of the Citation Indices by the Institute of Scientific Information (ISI) in the 1960s. These systems are used to normalize citation counts with respect to field-specific citation patterns. The best known system is the so-called "Web-of-Science Subject Categories" (WCs). In other systems papers are classified by algorithmic solutions. Using the Journal Citation Reports 2014 of the Science Citation Index and the Social Science Citation Index (n of journals = 11,149), we examine options for developing a new system based on journal classifications into subject categories using aggregated journal-journal citation data. Combining routines in VOSviewer and Pajek, a tree-like classification is developed. At each level one can generate a map of science for all the journals subsumed under a category. Nine major fields are distinguished at the top level. Further decomposition of the social sciences is pursued for the sake of example with a focus on journals in information science (LIS) and science studies (STS). The new classification system improves on alternative options by avoiding the problem
Student attitudes and approaches to problem solving can impact how well they learn physics. Prior research in the US using a validated Attitude and Approaches to Problem Solving (AAPS) survey suggests that there are major differences between students in introductory physics and astronomy courses and physics experts in terms of their attitudes and approaches to physics problem solving. Here we discuss the validation, administration and analysis of data for the Turkish version of the AAPS survey for high school and university students in Turkey. After the validation and administration of the Turkish version of the survey, the analysis of the data was conducted by grouping the data by grade level, school type, and gender. While there are no statistically significant differences between the averages of various groups on the survey, overall, the university students in Turkey were more expert-like than vocational high school students. On an item by item basis, there are statistically differences between the averages of the groups on many items. For example, on average, the university students demonstrated less expert-like attitudes about the role of equations and formulas in problem solv
For a nullhomologous Legendrian knot in a closed contact 3-manifold Y we consider a contact structure obtained by positive rational contact surgery. We prove that in this situation the Heegaard Floer contact invariant of Y is mapped by a surgery cobordism to the contact invariant of the result of contact surgery. In addition we characterize the spin-c structure on the cobordism that induces the relevant map. As a consequence we determine necessary and sufficient conditions for the nonvanishing of the contact invariant after rational surgery when Y is the standard 3-sphere, generalizing previous results of Lisca-Stipsicz and Golla. In fact our methods allow direct calculation of the contact invariant in terms of the rational surgery mapping cone of Ozsváth and Szabó. The proof involves a construction called reducible open book surgery, which reduces in special cases to the capping-off construction studied by Baldwin.