Comparison of nine trauma scoring systems in prediction of inhospital outcomes of pediatric trauma patients: a multicenter study.

Hereby, we aimed to comprehensively compare different scoring systems for pediatric trauma and their ability to predict in-hospital mortality and intensive care unit (ICU) admission. The current registry-based multicenter study encompassed a comprehensive dataset of 6709 pediatric trauma patients aged ≤ 18 years from July 2016 to September 2023. To ascertain the predictive efficacy of the scoring systems, the area under the receiver operating characteristic curve (AUC) was calculated. A total of 720 individuals (10.7%) required admission to the ICU. The mortality rate was 1.1% (n = 72). The most predictive scoring system for in-hospital mortality was the adjusted trauma and injury severity score (aTRISS) (AUC = 0.982), followed by trauma and injury severity score (TRISS) (AUC = 0.980), new trauma and injury severity score (NTRISS) (AUC = 0.972), Glasgow coma scale (GCS) (AUC = 0.9546), revised trauma score (RTS) (AUC = 0.944), pre-hospital index (PHI) (AUC = 0.936), injury severity score (ISS) (AUC = 0.901), new injury severity score (NISS) (AUC = 0.900), and abbreviated injury scale (AIS) (AUC = 0.734). Given the predictive performance of the scoring systems for ICU admission, NTRISS had the highest predictive performance (AUC = 0.837), followed by aTRISS (AUC = 0.836), TRISS (AUC = 0.823), ISS (AUC = 0.807), NISS (AUC = 0.805), GCS (AUC = 0.735), RTS (AUC = 0.698), PHI (AUC = 0.662), and AIS (AUC = 0.651). In the present study, we concluded the superiority of the TRISS and its two derived counterparts, aTRISS and NTRISS, compared to other scoring systems, to efficiently discerning individuals who possess a heightened susceptibility to unfavorable consequences. The significance of these findings underscores the necessity of incorporating these metrics into the realm of clinical practice.

Evaluating the Toxicity and Histological Effects of Al2O3 Nanoparticles on Bone Tissue in Animal Model: A Case-Control Study.

The applications of nanostructures have been limited by their different toxicities. So, the investigation of these toxicities is necessary before nanostructure application. This study aimed to evaluate the effect of aluminum oxide (Al2O3) nanoparticles on bone density in Wistar rat. Al2O3 nanoparticle was prepared by the sol-gel method. Characterization was done by X-ray diffraction (XRD) and transmission electron microscopy (TEM). Sixty-four male adult Wistar rats were divided into eight groups including six groups intravenously treated with Al2O3 nanoparticle at concentrations of 25, 50, 100, 250, 500, and 1000 µg/ml: one group received food and water as the control group, and one group received food and water as well as intravenously distilled water as an injection control group. After 41 days, bone density was analyzed by dual-energy X-ray absorptiometry (DEXA). According to X-ray diffraction, the average particle size for Al2O3 nanoparticles was 20.85 nm. The data of densitometry showed that the bone density of right and left foot was reduced in concentrations of 250, 500, and 1000 µg/ml that were statistically significant in comparison with the control group. The reduction of bone density was increased with the enhancement of nanostructures concentration. The effect of Al2O3 nanoparticles on bone density was similar in the left and right legs. Histopatholological assessment also showed that Al2O3 nanoparticles (250, 500, and 1000 µg/ml) lead to significant reduction of trabeculae. Empty lacunae are observed in these three groups. Considering that high concentrations of Al2O3 nanoparticles had toxicity on bone tissue, it must be used by more caution, especially its use as a coating in different devices such as implants, surgical instruments, and bone prostheses.

Motor aphasia as a rare presentation of fat embolism syndrome; a case report.

Fat embolism syndrome is a clinical diagnosis, and diagnostic procedures are not specific. In every trauma patient, Fat embolism syndrome has to be considered as a possibility and supportive treatment should begin as soon as possible. The authors reported a rare case of Fat embolism syndrome whose only neurological symptom was motor aphasia. A young man sustained comminuted femoral shaft fracture following an accident presented dyspnea, motor aphasia and petechial rash. The Po2 and O2 Saturation were 53 and 91.1%. The body temperature was 38.5 °C. The hemoglobin decreased from 12.9 to 8.7 and platelet from 121000 to 84000 mg/dl. The pulse rate was 120 bpm. The CT scan and MRI were normal. Fat embolism syndrome was diagnosed according to both Gurd and Schonfeld criteria ruling out other possible causes. Patient recovered completely. Although rare, focal neurological symptoms and motor aphasia should be kept in mind as a part of diagnostic criteria.