Contemporary Utilization and Outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta for Traumatic Noncompressible Torso Hemorrhage in Korea: A Retrospective Multi-Center Study

Purpose This study aimed to evaluate the utilization and outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) in managing noncompressible torso hemorrhage (NCTH) among trauma patients in Korea. The evolution of REBOA and its impact on patient survival was investigated as well as predictors of mortality. Methods This retrospective study included 234 post-REBOA patients from 5 leading regional trauma centers across Korea between 2016 and 2021. Primary outcomes were in-hospital mortality, and secondary outcomes were various clinical parameters regarding REBOA, overall treatment flow, and complications. For comparative analyses, patients were dichotomized into in-hospital non-survivors or survivors. Then, generalized additive and linear regression models were used to evaluate the trend of in-hospital mortality. Results The overall in-hospital mortality was 65.4%. The survivors had a higher proportion of responders following REBOA (87.7% vs 62.7%, p < 0.001). Key variables influencing outcomes included total occlusion time, red blood cell transfusion volume within the first 24 hours, revised trauma score, and systolic blood pressure gap. These factors significantly correlated with mortality rates in multivariate logistic regression. Conclusion Over 6 years, survival rates for NCTH patients undergoing REBOA in Korea have shown improvement. Despite diverse REBOA protocols across institutions, the results underscore the need for continued research, standardized practices, and national quality control measures to further optimize patient outcome and establish more effective treatment protocols for NCTH

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Mortality and Morbidity in Severely Traumatized Elderly Patients

Background: As the population ages, the elderly will constitute a prominent proportion of trauma patients. The elderly suffer more severe outcomes from injuries compared with the young. In this study, we examined the relationship between mortality and complications with age. Methods: This study was a retrospective review of 256 major trauma patients (Injury Severity Score &amp;gt; 15) admitted to an emergency center over a two- year period. Age-dependent mortality and complications were evaluated. Results: Of 256 patients, 209 (81.6%) were male and the mean age was 47.2 years. There was a trend between increasing age and increasing mortality, but this was not statistically significant. Increasing age was correlated with frequency of complications. Conclusions: Age was confirmed to be an independent predictor of mortality in major trauma. We documented that elderly trauma patients suffer from complications more frequently compared with their younger counterparts. Appropriate and specific triage and management guidelines for elderly trauma patients are needed

Canonical Cointegrating Regression and Testing for Cointegration in the Presence of I(1) and I(2) Variables

This paper introduces tests for the null of cointegration in the presence of I (1) and I (2) variables. These tests use residuals from Park's (1992, Econometrica 60,119–143) canonical cointegrating regression (CCR) and the leads-and-lags regression of Saikkonen (1991, Econometric Theory 9,1–21) and Stock and Watson (1993, Econometrica 61, 783–820). Asymptotic theory for CCR in the presence of I (1) and I (2) variables is also introduced. The distributions of the cointegration tests are nonstandard, and hence their percentiles are tabulated by using simulation. Monte Carlo simulation results to study the finite sample performance of the CCR estimates and the cointegration tests are also reported.

Fault Detection in IP-based Process Control Networks using Data Mining

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Low-temperature synthesis of highly crystalline TiO2 nanocrystals and their application to photocatalysis

Synthesis of highly crystalline TiO2 nanocrystals with various shapes and crystal structures from controlled aqueous sol-gel reactions at room temperature was investigated. The HRTEM image of these nanorods showed zigzag surface features with the [001] direction of the anatase being parallel to the long axis of the nanorods, which is very similar to the characteristics of the anatase nanorods. The BET surface areas of the spherical anatase nanocrystals, anatase nanorods, and rutile nanorods were found to be different in all the three. TiO2 nanocrystals with mixed crystal structures and various shapes were generated in the absence of the P-123 polymer. The results demonstrated that the presence of salt or acid was essential to synthesize the TiO2 nanocrystals with unique shapes and crystal structures and the P-123 controls the hydrolysis and condensation of the titanium tetraisopropoxide precursor.

Acute Physiology and Chronic Health Evaluation II Score and Sequential Organ Failure Assessment Score as Predictors for Severe Trauma Patients in the Intensive Care Unit

Background The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system and the Sequential Organ Failure Assessment (SOFA) scoring system are widely used for critically ill patients. We evaluated whether APACHE II score and SOFA score predict the outcome for trauma patients in the intensive care unit (ICU). Methods We retrospectively analyzed trauma patients admitted to the ICU in a single trauma center between January 2014 and December 2015. The APACHE II score was figured out based on the data acquired from the first 24 hours of admission; the SOFA score was evaluated based on the first 3 days in the ICU. A total of 241 patients were available for analysis. Injury Severity score, APACHE II score, and SOFA score were evaluated. Results The overall survival rate was 83.4%. The non-survival group had a significantly high APACHE II score (24.1 ± 8.1 vs. 12.3 ± 7.2, P < 0.001) and SOFA score (7.7 ± 1.7 vs. 4.3 ± 1.9, P < 0.001) at admission. SOFA score had the highest areas under the curve (0.904). During the first 3 days, SOFA score remained high in the non-survival group. In the non-survival group, cardiovascular system, neurological system, renal system, and coagulation system scores were significantly higher. Conclusions In ICU trauma patients, both SOFA and APACHE II scores were good predictors of outcome, with the SOFA score being the most effective. In trauma ICU patients, the trauma scoring system should be complemented, recognizing that multi-organ failure is an important factor for mortality