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Background@#Assessing and improving the quality of trauma care is crucial in modern trauma systems and centers. In Korea, evaluations of regional trauma centers are conducted annually to assess and improve trauma management quality. This includes using the Trauma and Injury Severity Score (TRISS) method to calculate the W-score and mortality Observed-to-Expected ratio (O:E ratio), which are used to evaluate the quality of care. We analyzed the potential for overestimation of the probability of survival using TRISS method for patients with neurotrauma, as well as the potential for errors when evaluating and comparing regional trauma centers. @*Methods@#We included patients who visited the regional trauma center between 2019 and 2021 and compared their probability of survival of the TRISS method, W-score, mortality O:E ratio, and misclassification rates. The patient groups were further subdivided into smaller subgroups based on age, Glasgow Coma Scale (GCS), and Injury Severity Score, and comparisons were made between the neurotrauma and non-neurotrauma groups within each subgroup. @*Results@#A total of 4,045 patients were enrolled in the study, with 1,639 of them having neurotrauma. The neurotrauma patient group had a W-score of −0.68 and a mortality O:E ratio of 1.044. The misclassification rate was found to be 13.3%, and patients with a GCS of 8 or less had a higher misclassification rate of 37.4%. @*Conclusion@#The limitations of using the TRISS method for predicting outcomes in patients with severe neurotrauma are exposed in this study. The TRISS methodology demonstrated a high misclassification rate of approximately 40% in subgroups of patients with GCS less than 9, indicating that it may be less reliable in predicting outcomes for severely injured patients with low GCS. Clinicians and researchers should be cautious when using the TRISS method and consider alternative methods to evaluate patient outcomes and compare the quality of care provided by different trauma centers.
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Tixagevimab/cilgavimab is a monoclonal antibody used to prevent coronavirus disease 2019 among immunocompromised hosts and maintained neutralizing activity against early omicron variants. Omicron BN.1 became a dominant circulating strain in Korea early 2023, but its susceptibility to tixagevimab/cilgavimab is unclear. We conducted plaque reduction neutralization test (PRNT) against BN.1 in a prospective cohort (14 patients and 30 specimens). BN.1 PRNT was conducted for one- and three-months after tixagevimab/ cilgavimab administration and the average PRNT ND 50 of each point was lower than the positive cut-off value of 20 (12.9 ± 4.5 and 13.2 ± 4.2, respectively, P = 0.825). In the paired analyses, tixagevimab/cilgavimab-administered sera could not actively neutralize BN.1 (PRNT ND 50 11.5 ± 2.9, P = 0.001), compared with the reserved activity against BA.5 (ND 50 310.5 ± 180.4). Unlike virus-like particle assay, tixagevimab/cilgavimab was not active against BN.1 in neutralizing assay, and would not be effective in the present predominance of BA.2.75 sublineages.
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Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been acknowledged as an effective mean of preventing infection and hospitalization.However, the emergence of highly transmissible SARS-CoV-2 variants of concern (VOCs) has led to substantial increase in infections among children and adolescents. Vaccineinduced immunity and longevity have not been well defined in this population. Therefore, we aimed to analyze humoral and cellular immune responses against ancestral and SARSCoV-2 variants after two shots of the BNT162b2 vaccine in healthy adolescents. Although vaccination induced a robust increase of spike-specific binding Abs and neutralizing Abs against the ancestral and SARS-CoV-2 variants, the neutralizing activity against the Omicron variant was significantly low. On the contrary, vaccine-induced memory CD4+ T cells exhibited substantial responses against both ancestral and Omicron spike proteins.Notably, CD4+ T cell responses against both ancestral and Omicron strains were preserved at 3 months after two shots of the BNT162b2 vaccine without waning. Polyfunctionality of vaccine-induced memory T cells was also preserved in response to Omicron spike protein.The present findings characterize the protective immunity of vaccination for adolescents in the era of continuous emergence of variants/subvariants.
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Objective@#The Rotterdam scoring system (RSS) is useful for prognosis prediction in patients with severe traumatic brain injury (sTBI). It comprises basal cistern, midline shifting (MLS), epidural hematoma (EDH), and subarachnoid hemorrhage (SAH)/intraventricular hemorrhage (IVH) status. Brain computed tomography (CT) is important to assessing patients with sTBI; however, results often change over time. We aimed to determine whether RSS outcome prediction differs by initial brain CT scan time after the trauma in patients with sTBI. @*Methods@#We used data from the second Korea Neurotrauma Data Bank, and analyzed 455 patients; RSS, Glasgow Outcome Scale Extended (GOSE) on 6-months, and the CT scan time were obtained. Unfavorable outcomes were defined as a GOSE score of 1–4. Participants were divided into 2 groups according to when brain CT scan was performed (> or ≤ 2 hours after trauma). The relationship between the prognosis of patients with sTBI and RSS score was examined by calculating the odds ratios. Univariate and multivariate analyses were performed. @*Results@#In both univariate and multivariate analysis, the total RSS and basal cistern status were statistically correlated with prognosis in both groups. EDH and SAH/IVH showed statistically significant difference according to CT scan time. MLS was associated with prognosis in both groups in univariate analysis although not in multivariate analysis. @*Conclusion@#The total RSS score predicted prognosis 6 months after trauma in patients with sTBI, regardless of CT scan time. However, the prognostic predictive power of each item constituting the RSS varied according to CT scan time.
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Shunt malfunction is the most common cause of ventriculoperitoneal shunt failure. In literature, occlusion of the tube with brain parenchyma, choroid plexus, blood, and proteinaceous debris has been suggested as a mechanism of obstruction. We herein report a case of shunt malfunction without any identifiable occlusion. Our case findings suggest that unapparent abdominal pathology, including inflammation and fibrosis, should be considered when treating shunt failures.
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Concerns about the effectiveness of current vaccines against the rapidly spreading severe acute respiratory syndrome-coronavirus-2 omicron (B.1.1.529) variant are increasing. This study aimed to assess neutralizing antibody activity against the wild-type (BetaCoV/Korea/ KCDC03/2020), delta, and omicron variants after full primary and booster vaccinations with BNT162b2. A plaque reduction neutralization test was employed to determine 50% neutralizing dilution (ND 50 ) titers in serum samples. ND 50 titers against the omicron variant (median [interquartile range], 5.3 [50 titers than the detection threshold (50 titers against BetaCoV/Korea/KCDC03/2020, delta, and omicron, although titers against omicron remained lower than those against the other variants (P < 0.001). Our study suggests that booster vaccination with BNT162b2 significantly increases humoral immunity against the omicron variant.
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The superior gluteal artery is branched from the internal iliac artery and is located outside the pelvis through a greater sciatic notch. This anatomical characteristic makes the artery vulnerable to injury when pelvic fracture involves the sciatic notch. In the case of a superior gluteal artery injury, hemodynamic instability can occur, and appropriate evaluation and management are mandatory in the acute phase. On the other hand, if the initial detection of the injury is neglected due to a masked pattern, it can cause massive bleeding during surgery, resulting in difficult hemostasis. This paper reports an experience of a latent superior gluteal artery injury by entrapment between the fragments of a transverse acetabular fracture.
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Objective@#: The widely accepted treatment option of a traumatic carotid cavernous fistula (TCCF) has been detachable balloon or coils based fistula occlusion. Recently, covered stent implantation has been proving an excellent results. The purpose of this study is to investigate our experiences with first line choice of covered stent implantation for TCCF at level 1 regional trauma center. @*Methods@#: From November 2004 to February 2020, 19 covered stents were used for treatment of 19 TCCF patients. Among them, 15 cases were first line treatment using covered stents. Clinical and angiographic data were retrospectively reviewed. @*Results@#: Procedures were technically successful in all 15 cases (100%). Immediate angiographic results after procedure were total occlusion in 12 patients (80%). All patients except two expired patients had image follow-up (mean 15 months). Recurred symptomatic three patients underwent additional treatments and achieved complete occlusion. Mean clinical follow-up duration was 32 months and results were modified Rankin Scale 1–2 in five, 3–4 in five, and 5 in three patients. @*Conclusion@#: The covered stent could be considered as fist line treatment option for treating TCCF patients especially in unstable vital sign. Larger samples and expanded follow-up are required to further develop their specifications and indications.
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Objective@#: The widely accepted treatment option of a traumatic carotid cavernous fistula (TCCF) has been detachable balloon or coils based fistula occlusion. Recently, covered stent implantation has been proving an excellent results. The purpose of this study is to investigate our experiences with first line choice of covered stent implantation for TCCF at level 1 regional trauma center. @*Methods@#: From November 2004 to February 2020, 19 covered stents were used for treatment of 19 TCCF patients. Among them, 15 cases were first line treatment using covered stents. Clinical and angiographic data were retrospectively reviewed. @*Results@#: Procedures were technically successful in all 15 cases (100%). Immediate angiographic results after procedure were total occlusion in 12 patients (80%). All patients except two expired patients had image follow-up (mean 15 months). Recurred symptomatic three patients underwent additional treatments and achieved complete occlusion. Mean clinical follow-up duration was 32 months and results were modified Rankin Scale 1–2 in five, 3–4 in five, and 5 in three patients. @*Conclusion@#: The covered stent could be considered as fist line treatment option for treating TCCF patients especially in unstable vital sign. Larger samples and expanded follow-up are required to further develop their specifications and indications.
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BACKGROUND@#Circulating tumor cells (CTCs) are frequently detected in patients with advanced-stage malignant tumors and could act as a predictor of poor prognosis. However, there is a paucity of data on the relationship between CTC number and primary tumor volume in patients with lung cancer. Therefore, our study aimed to evaluate the relationship between CTC number and primary tumor volume in patients with lung adenocarcinoma.@*METHODS@#We collected blood samples from 21 patients with treatment-naive lung adenocarcinoma and 73 healthy individuals. To count CTCs, we used a CTC enrichment method based on fluid-assisted separation technology. We compared CTC numbers between lung adenocarcinoma patients and healthy individuals using propensity score matching, and performed linear regression analysis to analyze the relationship between CTC number and primary tumor volume in lung adenocarcinoma patients.@*RESULTS@#CTC positivity was significantly more common in lung adenocarcinoma patients than in healthy individuals (p<0.001). The median primary tumor volume in CTC-negative and CTC-positive patients was 10.0 cm³ and 64.8 cm³, respectively. Multiple linear regression analysis showed that the number of CTCs correlated with primary tumor volume in lung adenocarcinoma patients (β=0.903, p=0.002). Further subgroup analysis showed a correlation between CTC number and primary tumor volume in patients with distant (p=0.024) and extra-thoracic (p=0.033) metastasis (not in patients with distant metastasis).@*CONCLUSION@#Our study showed that CTC numbers may be associated with primary tumor volume in lung adenocarcinomas patients, especially in those with distant metastasis.
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BACKGROUND@#Circulating tumor cells (CTCs) are frequently detected in patients with advanced-stage malignant tumors and could act as a predictor of poor prognosis. However, there is a paucity of data on the relationship between CTC number and primary tumor volume in patients with lung cancer. Therefore, our study aimed to evaluate the relationship between CTC number and primary tumor volume in patients with lung adenocarcinoma.@*METHODS@#We collected blood samples from 21 patients with treatment-naive lung adenocarcinoma and 73 healthy individuals. To count CTCs, we used a CTC enrichment method based on fluid-assisted separation technology. We compared CTC numbers between lung adenocarcinoma patients and healthy individuals using propensity score matching, and performed linear regression analysis to analyze the relationship between CTC number and primary tumor volume in lung adenocarcinoma patients.@*RESULTS@#CTC positivity was significantly more common in lung adenocarcinoma patients than in healthy individuals (p<0.001). The median primary tumor volume in CTC-negative and CTC-positive patients was 10.0 cm³ and 64.8 cm³, respectively. Multiple linear regression analysis showed that the number of CTCs correlated with primary tumor volume in lung adenocarcinoma patients (β=0.903, p=0.002). Further subgroup analysis showed a correlation between CTC number and primary tumor volume in patients with distant (p=0.024) and extra-thoracic (p=0.033) metastasis (not in patients with distant metastasis).@*CONCLUSION@#Our study showed that CTC numbers may be associated with primary tumor volume in lung adenocarcinomas patients, especially in those with distant metastasis.
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Traumatic retropharyngeal hematoma is a potentially life-threatening complication of cervical spine injury due to possible airway obstruction. Treatment by securing airway and subsequent conservative care is often adequate. However, a rapidly expanding large hematoma requires surgical evacuation. We present a case of 55-year-old man with a retropharyngeal hematoma secondary to cervical vascular injury without associated cervical fracture. The patient was successfully treated with endovascular arterial embolization and subsequent percutaneous drainage under fluoroscopic guidance without any sequelae.
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Humanos , Adenocarcinoma , Modelos Lineales , Neoplasias Pulmonares , Pulmón , Métodos , Metástasis de la Neoplasia , Células Neoplásicas Circulantes , Pronóstico , Puntaje de Propensión , Carga TumoralRESUMEN
OBJECTIVE: In general, quadriplegic patients use their voices to call the caregiver. However, severe quadriplegic patients are in a state of tracheostomy, and cannot generate a voice. These patients require other communication tools to call caregivers. Recently, monitoring of eye status using artificial intelligence (AI) has been widely used in various fields. We made eye status monitoring system using deep learning, and developed a communication system for quadriplegic patients can call the caregiver. METHODS: The communication system consists of 3 programs. The first program was developed for automatic capturing of eye images from the face using a webcam. It continuously captured and stored 15 eye images per second. Secondly, the captured eye images were evaluated for open or closed status by deep learning, which is a type of AI. Google TensorFlow was used as a machine learning tool or library for convolutional neural network. A total of 18,000 images were used to train deep learning system. Finally, the program was developed to utter a sound when the left eye was closed for 3 seconds. RESULTS: The test accuracy of eye status was 98.7%. In practice, when the quadriplegic patient looked at the webcam and closed his left eye for 3 seconds, the sound for calling a caregiver was generated. CONCLUSION: Our eye status detection software using AI is very accurate, and the calling system for the quadriplegic patient was satisfactory.
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Humanos , Inteligencia Artificial , Cuidadores , Aprendizaje , Aprendizaje Automático , Cuadriplejía , Traqueostomía , Aprendizaje Automático no Supervisado , VozRESUMEN
OBJECTIVE: This retrospective study was conducted to investigate the relationship between the superior sagittal sinus (SSS) to bone flap distance and clinical outcome in patients with traumatic brain injury (TBI) who underwent decompressive craniectomy (DC). METHODS: A retrospective review of medical records identified 255 adult patients who underwent DC with hematoma removal to treat TBI at our hospital from 2016 through 2017; of these, 68 patients met the inclusion criteria and underwent unilateral DC. The nearest SSS to bone flap distances were measured on postoperative brain computed tomography images, and patients were divided into groups A (distance ≥20 mm) and B (distance < 20 mm). The estimated blood loss (EBL) and operation time were evaluated using anesthesia records, and the time spent in an intensive care unit (ICU) was obtained by chart review. The clinical outcome was rated using the extended Glasgow Outcome Scale (GOS-E) at 3 and 6 months postoperatively. RESULTS: The male to female ratio was 15:2 and the mean subject age was 55.12 years (range, 18–79 years). The mean EBL and operation times were significantly different between groups A and B (EBL: 655.26 vs. 1803.33 mL, p < 0.001; operation time: 125.92 vs. 144.83 min, p < 0.001). The time spent in the ICU and GOS-E scores did not differ significantly between the groups. CONCLUSION: We recommend that when DC is indicated due to TBI, an SSS to bone flap distance of at least 20 mm should be maintained, considering the EBL, operation time, and other outcomes.
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Adulto , Femenino , Humanos , Masculino , Anestesia , Encéfalo , Lesiones Encefálicas , Craniectomía Descompresiva , Escala de Consecuencias de Glasgow , Hematoma , Unidades de Cuidados Intensivos , Registros Médicos , Estudios Retrospectivos , Seno Sagital Superior , Centros TraumatológicosRESUMEN
Posterior fossa epidural hematoma (EDH) is uncommon, but the related clinical deterioration can occur suddenly. Accompanying venous sinus injury and lacerations are associated with 40% to 80% mortality. The authors present one clinical case of a patient with posterior fossa EDH from transverse sinus bleeding. A 57-year-old male was injured after falling while working. He was taken to the hospital, where computed tomography scans of his brain revealed a right posterior temporal and cerebellar EDH with a right temporo-occipital fracture. He underwent a right parieto-occipital craniotomy, incorporating the fracture line. Longitudinal laceration of the right transverse sinus extending to the sigmoid sinus with profuse bleeding was identified. Four gauzes were inserted in the epidural space for tamponade of the injured sinus. Conventional angiography and coil embolization for the injured sinus were immediately performed. Subsequently, the patient was transferred to the operating room, wherein staff members removed the gauzes and remnant hematoma. Based on this experience, the authors recommend that for posterior fossa EDH from transverse sinus bleeding, bleeding control should be performed by gauze packing and endovascular treatment.
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Humanos , Masculino , Persona de Mediana Edad , Accidentes por Caídas , Angiografía , Encéfalo , Colon Sigmoide , Fosa Craneal Posterior , Craneotomía , Embolización Terapéutica , Espacio Epidural , Hematoma , Hematoma Epidural Craneal , Hemorragia , Laceraciones , Mortalidad , QuirófanosRESUMEN
The authors present two clinical cases, in which intraoperative transcranial sonography (TCS) was used to detect a change in contralateral hematoma volume. A 51-year-old female and a 5-year-old male underwent osteoplastic craniotomy for epidural hematoma removal. Scant contralateral hematoma was evident by preoperative computed tomography in both patients. Intraoperative TCS was used to detect changes in contralateral hematomas. After observing a volume change in one case, a second operation was performed immediately. Based in this experience, the authors recommend intraoperative TCS for the detection of contralateral hematoma volume changes.
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Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Lesiones Encefálicas , Craneotomía , Hematoma , Presión Intracraneal , UltrasonografíaRESUMEN
OBJECTIVE: Preventable and potentially preventable traumatic death rates is a method to evaluate the preventability of the traumatic deaths in emergency medical department. To evaluate the preventability of the traumatic deaths in patients who were admitted to neurosurgery department, we performed this study. METHODS: A retrospective review identified 52 patients who admitted to neurosurgery department with severe traumatic brain injuries between 2013 and 2014. Based on radiologic and clinical state at emergency room, each preventability of death was estimated by professional panel discussion. And the final death rates were calculated. RESULTS: The preventable and potentially preventable traumatic death rates was 19.2% in this study. This result is lower than that of the research of 2012, Korean preventable and potentially preventable traumatic death rates. The rate of preventable and potentially preventable traumatic death of operation group is lower than that of conservative treatment group. Also, we confirmed that direct transfer and the time to operation are important to reduce the preventability. CONCLUSION: We report the preventable and potentially preventable traumatic death rates of our institute for evaluation of preventability in severe traumatic brain injuries during the last 2 years. For decrease of preventable death, we suggest that continuous survey of the death rate of traumatic brain injury patients is required.
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Humanos , Lesiones Encefálicas , Urgencias Médicas , Servicio de Urgencia en Hospital , Métodos , Mortalidad , Neurocirugia , Estudios RetrospectivosRESUMEN
OBJECTIVE: Injuries of upper cervical spine are potentially fatal. Thus, appropriate diagnosis and treatment is essential. In our institute, preoperative computed tomography angiography (CTA) has been performed for evaluation of injuries of bony and vascular structure. The authors confirmed the engorged venous plexus within injured posterior neck muscle. We have this research to clarify the relationship between the engorged venous plexus and engorged vein. METHODS: A retrospective review identified 23 adult patients who underwent 23 posterior cervical spine surgeries for treatment of upper cervical injury between 2013 and 2015. Preoperative CTA was used to identify of venous engorgement within posterior neck muscle. The male to female ratio was 18:5 and the mean age was 53.5 years (range, 25-78 years). Presence of venous engorgement and estimated blood loss (EBL) were analyzed retrospectively. RESULTS: The EBL of group with venous engorgement was 454.55 mL. The EBL of group without venous engorgement was 291.67 mL. The EBL of group with venous engorgement was larger than control group in significant. CONCLUSION: The presence of engorged venous plexus is important factor of intraoperative bleeding. Preoperative CTA for identifying of presence of engorged venous plexus and fine operative techniques is important to decrease of blood loss during posterior cervical spine surgery.
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Adulto , Femenino , Humanos , Masculino , Angiografía , Pérdida de Sangre Quirúrgica , Diagnóstico , Hemorragia , Hiperemia , Músculos del Cuello , Cuello , Estudios Retrospectivos , Traumatismos Vertebrales , Columna Vertebral , VenasRESUMEN
OBJECTIVE: Decompressive craniectomy (DC) is a widely used surgical procedure for control of severely increased intracranial pressure in various conditions. The goal of this study is to evaluate the effectiveness of the addition of resection of temporalis muscle and fascia in DC particularly in the treatment of traumatic brain injury. METHODS: Twenty patients underwent temporalis muscle and fascia resection in addition to conventional DC and duroplasty due to massive brain swelling in a single tertiary hospital from 2013 to 2015 were enrolled. Twenty other patients who received the standard techniques by other neurosurgeons in the same period were gathered for the control group. Postoperative computed tomography (CT) as well as functional outcome in both groups were analyzed retrospectively. RESULTS: CT volumetry showed a significant increase of 85.19 mL (p<0.001) of extracranial herniation volume in the research group compared with the control group. Using modified Rankin Scale and Glasgow Outcome Scale, there was no statistically significant difference in functional outcome between the two groups. CONCLUSION: Although preliminary, the procedure appears to show a meaningful increase in extracranial herniation volume with minimal masticatory and cosmetic impairment.