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Personalized Medicine in Trauma Resuscitation and Treatment

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Methodology, Drug and Device Discovery".

Deadline for manuscript submissions: closed (15 November 2022) | Viewed by 25699

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Special Issue Editor

Dr. Sheng-Der Hsu

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Guest Editor

Department of Surgery, Division of Traumatic and General Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Interests: trauma; surgery; laparotomy; emergency management; critical care medicine

Special Issue Information

Dear Colleagues,

Over half of patients die at the scene of the accident or within 24 h of hospitalization after multiple major traumas, including blunt abdominal or thoracic trauma with massive bleeding and severe primary brain injury. Uncontrolled haemorrhage shock is the highest treatment priority for trauma surgeons. Hence early differential diagnosis, resuscitation, early intervention and successful post operative critical care play an important roles in trauma patients. This Special Issue is aimed at providing selected contributions on advances in the traumatic resuscitation, hemorrhage shock, hypotension, dressing materials, stop bleeding, devices, surgery, hemostasis, health care, endovascular intervention, images, minimal invasive surgery, non-operative management, Predictive factors, Prognosis, clinical studies, Healthcare system, Acute Care Surgery in the trauma field.

Potential topics include, but are not limited to:

Resuscitation
Hemorrhage shock
Surgery
Endovascular intervention
Minimal invasive surgery
Non-operative management
Prognosis
Acute Care Surgery

Dr. Sheng-Der Hsu
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

traumatic resuscitation
hemorrhage shock
hypotension
dressing materials
stop bleeding
devices
surgery
hemostasis
health care
endovascular intervention
images
minimal invasive surgery
non-operative management
predictive factors
prognosis
clinical studies
healthcare system
Acute Care Surgery

Published Papers (11 papers)

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Research

Jump to: Review

18 pages, 3222 KiB

Open AccessArticle

Proteomic Profiling of Outer Membrane Vesicles Released by Escherichia coli LPS Mutants Defective in Heptose Biosynthesis

by Yaw-Kwan Chiu, Ti Yin, Yi-Tzu Lee, Shyi-Jou Chen, Yung-Chih Wang and Kuo-Hsing Ma

J. Pers. Med. 2022, 12(8), 1301; https://doi.org/10.3390/jpm12081301 - 9 Aug 2022

Cited by 3 | Viewed by 2255

Abstract

Escherichia coli releases outer membrane vesicles (OMVs) into the extracellular environment. OMVs, which contain the outer membrane protein, lipopolysaccharides (LPS), and genetic material, play an important role in immune response modulation. An isobaric tag for relative and absolute quantitation (iTRAQ) analysis was used to investigate OMV constituent proteins and their functions in burn trauma. OMV sizes ranged from 50 to 200 nm. Proteomics and Gene Ontology analysis revealed that ΔrfaC and ΔrfaG were likely involved in the upregulation of the structural constituent of ribosomes for the outer membrane and of proteins involved in protein binding and OMV synthesis. ΔrfaL was likely implicated in the downregulation of the structural constituent of the ribosome, translation, and cytosolic large ribosomal subunit. Kyoto Encyclopedia of Genes and Genomes analysis indicated that ΔrfaC and ΔrfaG downregulated ACP, ACEF, and ADHE genes; ΔrfaL upregulated ACP, ACEF, and ADHE genes. Heat map analysis demonstrated upregulation of galF, clpX, accA, fabB, and grpE and downregulation of pspA, ydiY, rpsT, and rpmB. These results suggest that RfaC, RfaG, and RfaL proteins were involved in outer membrane and LPS synthesis. Therefore, direct contact between wounds and LPS may lead to apoptosis, reduction in local cell proliferation, and delayed wound healing. Full article

(This article belongs to the Special Issue Personalized Medicine in Trauma Resuscitation and Treatment)

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9 pages, 673 KiB

Open AccessArticle

Retrograde Intramedullary Kirschner Wire Fixation as an Alternative for Treating Distal Fibular Shaft Fractures Combined with Distal Tibial Pilon Fractures

by Cheng-Wei Huang, Wen-Tien Wu, Tsai-Chiu Yu, Ing-Ho Chen, Jen-Hung Wang and Kuang-Ting Yeh

J. Pers. Med. 2022, 12(7), 1124; https://doi.org/10.3390/jpm12071124 - 10 Jul 2022

Cited by 3 | Viewed by 1963

Abstract

Treatment or management techniques for pilon fractures are associated with high complication rates and poor outcomes. No consensus exists regarding the optimal surgical option for pilon fractures, especially for pilon fractures combined with distal fibular fractures. Accordingly, we explored the use of fibular fixation for treating pilon fractures involving distal fibular shaft fractures. We hypothesized that retrograde intramedullary Kirschner wire (K-wire) fixation is a suitable alternative technique for distal fibular fixation. We retrospectively reviewed the data of 156 patients who underwent surgery for pilon fractures at our hospital from May 2013 to May 2021. The radiographic and functional outcomes were comparable between the fibular intramedullary nailing (Group A; n = 80) and the fibular plating (Group B; n = 76) groups. Groups A and B differed significantly in total hospitalization time (11.4 vs. 18.2 days, p = 0.024), length of postoperative admission (6.8 vs. 11.4 days, p = 0.012), and total admission cost (USD 3624 vs. USD 6145, p = 0.004). We also noted that poor Olerud and Molander ankle scores were significantly associated with age (p = 0.008), smoking (p = 0.012), and preoperative admission length (p = 0.018). Retrograde intramedullary K-wire fixation produced a comparable 12-month functional outcome to plate fixation for distal fibular shaft fractures, rendering it a viable alternative method based on soft tissue condition. Full article

(This article belongs to the Special Issue Personalized Medicine in Trauma Resuscitation and Treatment)

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17 pages, 30587 KiB

Open AccessEditor’s ChoiceArticle

Hemostasis and Anti-Inflammatory Abilities of AuNPs-Coated Chitosan Dressing for Burn Wounds

by Juin-Hong Cherng, Cheng-An J. Lin, Cheng-Che Liu, Jue-Zong Yeh, Gang-Yi Fan, Hsin-Da Tsai, Chun-Fang Chung and Sheng-Der Hsu

J. Pers. Med. 2022, 12(7), 1089; https://doi.org/10.3390/jpm12071089 - 30 Jun 2022

Cited by 9 | Viewed by 2070

Abstract

Burn injuries are a common hazard in the military, as fire is likely to be weaponized. Thus, it is important to find an effective substance to accelerate burn wound healing. This study used chitosan and gold nanoparticles (AuNPs) as wound dressings and investigated their effectiveness in femoral artery hemorrhage swine and rat burn models. Chitosan dressing has significant hemostatic properties compared with gauze. Histological results showed that burn wounds treated with chitosan or AuNP-coated chitosan dressings exhibited more cells and a continuous structure of the epidermis and dermis than those of the control and untreated lesion groups. Furthermore, both chitosan dressings have been shown to positively regulate the expression of genes- and cytokines/chemokines-related to the wound healing process; AuNP-coated chitosan significantly lessened severe sepsis and inflammation, balanced the activities of pro-fibrotic and anti-fibrotic ligands for tissue homeostasis, regulated angiogenesis, and inhibited apoptosis activity, thereby being beneficial for the burn microenvironment. Hence, chitosan alone or in combination with AuNPs represents a prospective therapeutic substance as a burn dressing which might be helpful for burn wound care. This study provides a novel hemostasis dressing for modern warfare that is simple to use by most medical and paramedical personnel handling for burn treatment. Full article

(This article belongs to the Special Issue Personalized Medicine in Trauma Resuscitation and Treatment)

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10 pages, 285 KiB

Open AccessArticle

Risk Factors Associated with Cartilage Defects after Anterior Cruciate Ligament Rupture in Military Draftees

by Ting-Yi Sun, Chun-Liang Hsu, Wei-Cheng Tseng, Tsu-Te Yeh, Guo-Shu Huang and Pei-Hung Shen

J. Pers. Med. 2022, 12(7), 1076; https://doi.org/10.3390/jpm12071076 - 30 Jun 2022

Cited by 5 | Viewed by 1912

Abstract

This study aimed to evaluate the different clinical results and factors associated with cartilage defects in military draftees who underwent different treatments after anterior cruciate ligament (ACL) rupture. Overall, 105 patients who had sustained ACL rupture were military draftees who underwent a conscription examination for physical status assessment from January 2012 to December 2020. Patients were divided into three groups: conservative treatment after ACL rupture, status post-anterior cruciate ligament reconstruction (ACLR), but graft rupture, and status post-ACLR with graft intact. Inter-group comparisons and statistical analyses were performed for age, body mass index (BMI), thigh circumference difference, side-to-side difference in anterior knee translation by KT-2000, meniscus tear, and cartilage defect. Multivariate logistic regression analysis was used to determine the factors associated with cartilage defects. The multivariable regression model showed that BMI (odds ratio OR: 1.303; 95% CI: 1.016–1.672; p = 0.037), thigh circumference difference (OR: 1.403; 95% CI: 1.003–1.084; p = 0.034), tear of lateral meniscus (LM) and medial meniscus (MM) (OR: 13.773; 95% CI: 1.354–140.09; p = 0.027), and graft rupture group (OR: 5.191; 95% CI: 1.388–19.419; p = 0.014) increased the risk of cartilage defects. There was no correlation between cartilage defects and age, KT-2000 difference, tear of LM or MM, or graft intact group. Progression of osteoarthritis was concerned after ACL rupture, and this study identified several factors of post-ACLR graft rupture, greater thigh circumference difference, BMI, and meniscus tear of both LM and MM affecting cartilage defects, which represent early degenerative osteoarthritis changes of the knee. The results of this study should be customized for rehabilitation and military training, especially in military draftees with ACL injuries. Full article

(This article belongs to the Special Issue Personalized Medicine in Trauma Resuscitation and Treatment)

17 pages, 2937 KiB

Open AccessArticle

Evaluation of a Proportional–Integral–Derivative Controller for Hemorrhage Resuscitation Using a Hardware-in-Loop Test Platform

by Eric J. Snider, David Berard, Saul J. Vega, Guy Avital and Emily N. Boice

J. Pers. Med. 2022, 12(6), 979; https://doi.org/10.3390/jpm12060979 - 16 Jun 2022

Cited by 6 | Viewed by 1258

Abstract

Hemorrhage is a leading cause of preventable death in trauma, which can often be avoided with proper fluid resuscitation. Fluid administration can be cognitive-demanding for medical personnel as the rates and volumes must be personalized to the trauma due to variations in injury severity and overall fluid responsiveness. Thus, automated fluid administration systems are ideal to simplify hemorrhagic shock resuscitation if properly designed for a wide range of hemorrhage scenarios. Here, we highlight the development of a proportional–integral–derivative (PID) controller using a hardware-in-loop test platform. The controller relies only on an input data stream of arterial pressure and a target pressure; the PID controller then outputs infusion rates to stabilize the subject. To evaluate PID controller performance with more than 10 controller metrics, the hardware-in-loop platform allowed for 11 different trauma-relevant hemorrhage scenarios for the controller to resuscitate against. Overall, the two controller configurations performed uniquely for the scenarios, with one reaching the target quicker but often overshooting, while the other rarely overshot the target but failed to reach the target during severe hemorrhage. In conclusion, PID controllers have the potential to simplify hemorrhage resuscitation if properly designed and evaluated, which can be accomplished with the test platform shown here. Full article

(This article belongs to the Special Issue Personalized Medicine in Trauma Resuscitation and Treatment)

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11 pages, 558 KiB

Open AccessArticle

Association between 3D Printing-Assisted Pelvic or Acetabular Fracture Surgery and the Length of Hospital Stay in Nongeriatric Male Adults

by Chun-Chi Hung, Pei-Hung Shen, Jia-Lin Wu, Yung-Wen Cheng, Wei-Liang Chen, Shih-Han Lee and Tsu-Te Yeh

J. Pers. Med. 2022, 12(4), 573; https://doi.org/10.3390/jpm12040573 - 3 Apr 2022

Cited by 2 | Viewed by 1751

Abstract

Pelvic and acetabular fractures are challenging for orthopedic surgeons, but 3D printing has many benefits in treating these fractures and has been applied worldwide. This study aimed to determine whether 3D printing can shorten the length of hospital stay (LHS) in nongeriatric male adult patients with these fractures. This is a single-center retrospective study of 167 nongeriatric male adult participants from August 2009 to December 2021. Participants were divided into two groups based on whether they received 3D printing assistance. Subgroup analyses were performed. Pearson’s correlation and multivariable linear regression models were used to analyze the LHS and the parameters. Results showed that 3D printing-assisted surgery did not affect LHS in the analyzed patients. The LHS was positively correlated with the Injury Severity Score (ISS). Initial hemoglobin levels were negatively associated with LHS in patients aged 18–40 and non-major trauma (ISS < 16) patients. In 40–60-year-old and non-major trauma patients, the duration from fracture to admission was significantly associated with LHS. This study indicates that 3D-assisted technology for pelvic or acetabular fracture surgery for nongeriatric male adults does not influence the LHS. More importantly, the initial evaluation of patients in the hospital was the main predictor of the LHS. Full article

(This article belongs to the Special Issue Personalized Medicine in Trauma Resuscitation and Treatment)

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Graphical abstract

9 pages, 789 KiB

Open AccessArticle

Comparison of Long-Term Pneumonia Risk between Spleen Injury and Non-Spleen Injury after Total Splenectomy—A Population-Based Study

by Chun-Cheng Lin, Sheng-Der Hsu, Wu-Chien Chien, Chi-Hsiang Chung, Cheng-Jueng Chen, Chia-Ming Liang and Zhi-Jie Hong

J. Pers. Med. 2022, 12(2), 308; https://doi.org/10.3390/jpm12020308 - 18 Feb 2022

Viewed by 1815

Abstract

Patients who undergo splenectomy are at a high risk of infection. We aimed to investigate the rate of pneumonia in patients who underwent splenectomy, specifically comparing those who had splenectomy due to spleen injury and those who had it for other reasons. A population-based cohort study was conducted. Overall, 17,498 patients who underwent splenectomy between 2000 and 2015 were enrolled, including 11,817 patients with a history of spleen injury and 5681 controls without spleen injury. The incidence of pneumonia was calculated at the end of 2016. A multivariable Cox proportional hazards regression model was used to compare the hazard ratio with 95% CI for pneumonia associated with the spleen injury-caused splenectomy and splenectomy due to other causes. The crude HR for patients with splenectomy due to spleen injury to develop pneumonia was 1.649. After adjusting for covariates, the adjusted hazard ratio was 1.567. There were statistically significant differences in all subgroups, except for the group with a tracking duration >10 years. We found an increase in pneumonia risk in the ‘spleen injury’ group when comparing it to that of the ‘other causes’ group, regardless of age, sex, and area of residence. Full article

(This article belongs to the Special Issue Personalized Medicine in Trauma Resuscitation and Treatment)

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10 pages, 1881 KiB

Open AccessArticle

Traditional versus Minimally Invasive Spinopelvic Fixation for Sacral Fracture Treatment in Vertically Unstable Pelvic Fractures

by Yao-Tung Tsai, Yu-Ching Chou, Chia-Chun Wu and Tsu-Te Yeh

J. Pers. Med. 2022, 12(2), 262; https://doi.org/10.3390/jpm12020262 - 11 Feb 2022

Cited by 2 | Viewed by 1691

Abstract

Purpose: Numerous different fixation techniques are used to treat vertical shear sacral fractures. We report our experience with spinopelvic fixation using a minimally invasive technique. Methods: Thirty-eight patients with vertical pelvic and sacral fractures were treated with spinopelvic fixation (traditional open method, n = 21; minimally invasive technique, n = 17). Intergroup comparisons and statistical analysis were performed for intraoperative blood loss, operative time, post-operative radiographic grading, post-operative functional score, and complication rates. Results: Patients treated with the minimally invasive technique had a significantly shorter operative time (−52 min, p = 0.022), reduced blood loss volume (−287 mL, p < 0.001), and better cosmetic appearance (p < 0.05) than those in the traditional open group. There were no significant intergroup differences in post-operative radiographic grading (p = 0.489) or post-operative functional scores (p = 0.072). The complication rate was lower in the minimally invasive group (1/17 patients) than in the traditional open group (2/21 patients). Conclusions: Minimally invasive spinopelvic fixation is a viable treatment for sacral fractures and can reduce blood loss and operative time. Full article

(This article belongs to the Special Issue Personalized Medicine in Trauma Resuscitation and Treatment)

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Graphical abstract

12 pages, 41615 KiB

Open AccessArticle

Does 3D Printing-Assisted Acetabular or Pelvic Fracture Surgery Shorten Hospitalization Durations among Older Adults?

by Chun-Chi Hung, Jia-Lin Wu, Yung-Wen Cheng, Wei-Liang Chen, Shih-Han Lee and Tsu-Te Yeh

J. Pers. Med. 2022, 12(2), 189; https://doi.org/10.3390/jpm12020189 - 31 Jan 2022

Cited by 1 | Viewed by 2175

Abstract

Acetabular or anterior pelvic ring fractures are rare but extremely complicated and challenging injuries for orthopedic trauma surgeons. Three-dimensional (3D) printing technology is widely used in the management of these two fracture types for surgical benefits. Our study aimed to explore whether 3D printing-assisted acetabular or pelvic surgery is beneficial in terms of shortening the length of hospital stay (LHS) and intensive care unit (ICU) stay (ICU LS) for older patients. This retrospective study included two groups of 76 participants over 60 years old who underwent operations with (n = 41) or without (n = 35) guidance by 3D printing. The Mann–Whitney U test was used to analyze continuous variables. Chi-square analysis was applied for categorical variables. Univariable and multivariable linear regression models were used to analyze the factors associated with LHS. The median LHS in the group without 3D printing assistance was 16 (12–21) days, and the median ICU LS was 0 (0–2) days. The median LHS in the group with 3D printing assistance was 17 (12.5–22.5) days, and the median ICU LS was 0 (0–3) days. There was no significant difference in LHS associated with 3D printing assistance vs. that without 3D printing among patients who underwent open reduction and internal fixation for pelvic or acetabular fractures. The LHS positively correlated with the ICU LS whether the operation was 3D printing assisted or not. For fracture surgery in older patients, in addition to the advancement of surgical treatment and techniques, medical teams require more detailed preoperative evaluations, and more personalized medical plans regarding postoperative care to achieve the goals of shortening LHS, reducing healthcare costs, and reducing complication rates. Full article

(This article belongs to the Special Issue Personalized Medicine in Trauma Resuscitation and Treatment)

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16 pages, 1905 KiB

Open AccessArticle

Simple and Efficient Pressure Ulcer Reconstruction via Primary Closure Combined with Closed-Incision Negative Pressure Wound Therapy (CiNPWT)—Experience of a Single Surgeon

by Kuo-Feng Hsu, Li-Ting Kao, Pei-Yi Chu, Chun-Yu Chen, Yu-Yu Chou, Dun-Wei Huang, Ting-Hsuan Liu, Sheng-Lin Tsai, Chien-Wei Wu, Chih-Chun Hou, Chih-Hsin Wang, Niann-Tzyy Dai, Shyi-Gen Chen and Yuan-Sheng Tzeng

J. Pers. Med. 2022, 12(2), 182; https://doi.org/10.3390/jpm12020182 - 29 Jan 2022

Cited by 4 | Viewed by 5715

Abstract

Background: In this study, we aimed to analyze the clinical efficacy of closed-incision negative pressure wound therapy (CiNPWT) when combined with primary closure (PC) in a patient with pressure ulcers, based on one single surgeon’s experience at our medical center. Methods: We retrospectively reviewed the data of patients with stage III or IV pressure ulcers who underwent reconstruction surgery. Patient characteristics, including age, sex, cause and location of defect, comorbidities, lesion size, wound reconstruction methods, operation time, debridement times, application of CiNPWT to reconstructed wounds, duration of hospital stay, and wound complications were analyzed. Results: Operation time (38.16 ± 14.02 vs. 84.73 ± 48.55 min) and duration of hospitalization (36.78 ± 26.92 vs. 56.70 ± 58.43 days) were shorter in the PC + CiNPWT group than in the traditional group. The frequency of debridement (2.13 ± 0.98 vs. 2.76 ± 2.20 times) was also lower in the PC + CiNPWT group than in the traditional group. The average reconstructed wound size did not significantly differ between the groups (63.47 ± 42.70 vs. 62.85 ± 49.94 cm²), and there were no significant differences in wound healing (81.25% vs. 75.38%), minor complications (18.75% vs. 21.54%), major complications (0% vs. 3.85%), or mortality (6.25% vs. 10.00%) between the groups. Conclusions: Our findings indicate that PC combined with CiNPWT represents an alternative reconstruction option for patients with pressure ulcers, especially in those for whom prolonged anesthesia is unsuitable. Full article

(This article belongs to the Special Issue Personalized Medicine in Trauma Resuscitation and Treatment)

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Review

Jump to: Research

18 pages, 988 KiB

Open AccessEditor’s ChoiceReview

Closed-Loop Controlled Fluid Administration Systems: A Comprehensive Scoping Review

by Guy Avital, Eric J. Snider, David Berard, Saul J. Vega, Sofia I. Hernandez Torres, Victor A. Convertino, Jose Salinas and Emily N. Boice

J. Pers. Med. 2022, 12(7), 1168; https://doi.org/10.3390/jpm12071168 - 18 Jul 2022

Cited by 8 | Viewed by 1947

Abstract

Physiological Closed-Loop Controlled systems continue to take a growing part in clinical practice, offering possibilities of providing more accurate, goal-directed care while reducing clinicians’ cognitive and task load. These systems also provide a standardized approach for the clinical management of the patient, leading to a reduction in care variability across multiple dimensions. For fluid management and administration, the advantages of closed-loop technology are clear, especially in conditions that require precise care to improve outcomes, such as peri-operative care, trauma, and acute burn care. Controller design varies from simplistic to complex designs, based on detailed physiological models and adaptive properties that account for inter-patient and intra-patient variability; their maturity level ranges from theoretical models tested in silico to commercially available, FDA-approved products. This comprehensive scoping review was conducted in order to assess the current technological landscape of this field, describe the systems currently available or under development, and suggest further advancements that may unfold in the coming years. Ten distinct systems were identified and discussed. Full article

(This article belongs to the Special Issue Personalized Medicine in Trauma Resuscitation and Treatment)

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