Search Results (72)

Background: Cerebral amyloid angiopathy (CAA) is a common cause of spontaneous intracerebral hemorrhage (ICH) in elderly individuals, and it is characterized by the deposition of amyloid β protein (Aß) in the walls of small-caliber cortical and leptomeningeal vessels. The diagnostic criteria for CAA highlight its association with spontaneous lobar hemorrhage, convexity subarachnoid hemorrhage (SAH), and cortical superficial siderosis but not with subdural hematoma (SDH). This article presents a three-patient case series of CAA who experienced a lobar ICH associated with an SDH, underscoring a potentially under-recognized correlation between an acute ICH and coexistent SDH. Case presentation: We present a case series of three patients in a single university medical center who experienced acute-onset lobar ICH with a concurrent SDH, treated with evacuation. Histopathological examination established the diagnosis of CAA in all three cases. This case series underscores a potentially under-recognized association between an acute ICH and coexistent SDH in the context of CAA. Conclusions: Considering our findings, we emphasize the possibility that SDH may be a more frequent manifestation of CAA than previously recognized. Therefore, patients with CAA who initially present with acute SDH may be underdiagnosed, consequently leading to delayed identification and missed opportunities for proper risk assessment and management. Full article

Background and Objectives: Surgical smoke generated by energy devices during surgery contains hazardous substances and poses health risks to staff in the operating room. Exposure to surgical smoke must be reduced to minimize the risk of health hazards. Many studies have evaluated surgical smoke qualitatively, but few have performed quantitative assessment. The aim of this study was to quantify the number of particles generated during various breast surgery procedures. Materials and Methods: In this prospective, randomized study, breast surgeries performed at Tokyo Medical and Dental University Hospital (the present Institute of Science Tokyo Hospital) between December 2022 and August 2023 were randomly assigned to two groups: the electrosurgical device group and the electrosurgical device with smoke evacuator group. The number of particles generated by energy devices during surgery was measured using a particle counter. Results: Surgical smoke was generated in all procedures. The number of measured particles was significantly less in the electrosurgical device with smoke evacuator group than in the electrosurgical device group during all procedures (all p < 0.001). Conclusions: All breast surgery procedures produced a significant amount of surgical smoke, which was effectively reduced by using an electrosurgical device with a smoke evacuator. These findings support the routine use of smoke evacuators in breast surgery to reduce occupational exposure to hazardous particles. Implementation of such devices could improve operating room safety and may inform future guidelines and institutional policies regarding surgical smoke management. Full article

Based on the regional disaster system theory, this study constructed a comprehensive flood risk indicator system for small reservoirs, covering the entire flood disaster process from three dimensions: hazard, vulnerability, and exposure. The analytic hierarchy process (AHP) and entropy weight method (EW) were used to determine indicator weights, and a risk assessment was conducted for small reservoirs in Huangshan City, Anhui Province, China. The results indicate that most reservoirs exhibit medium–low overall risk, yet distinct localized high-risk zones exist. High-economic-density areas such as Tunxi District, the central–eastern parts of Huangshan District, and the central and eastern parts of Qimen County have become high-risk clusters due to prominent exposure indicators (numbers of villages and medical facilities). Reservoirs in western and northern regions exhibit higher hazard levels, primarily driven by rainfall and catchment areas. Dam height and reservoir capacity are the main factors affecting vulnerability, with no significant spatial clustering for high-vulnerability reservoirs. Through the decoupling of three-dimensional indicators, this study reveals the differentiated driving mechanisms of “hazard–vulnerability–exposure,” providing a scientific basis for optimizing flood control engineering (e.g., reservoir capacity expansion, dam reinforcement) and risk zoning management (e.g., emergency evacuation planning in high-exposure areas) for small reservoirs. Full article

Background and Clinical Significance: Local anesthetic injections, routine in dental practice, ensure pain control during procedures like root canal treatments. Though generally safe, they can occasionally cause hematomas, localized blood accumulations in tissue planes. Rapidly expanding hematomas in the head and neck are exceptionally rare but dangerous due to anatomical complexity, potentially threatening the airway. This case report emphasizes the critical need for the prompt recognition and management of such complications to prevent life-threatening outcomes, highlighting vigilance in routine dental procedures. Case Presentation: A 63-year-old male presented with rapidly enlarging right buccal swelling four hours post-local anesthetic injection for a root canal on a right maxillary molar. Examination showed warm, erythematous edema and buccal ecchymosis; a CT scan confirmed a 3.8 cm × 8.4 cm × 5.5 cm buccal space hematoma. His medical history revealed controlled type 2 diabetes and hyperlipidemia, and his coagulation was normal. Conservative management failed as the hematoma progressed, limiting mouth and eye opening. Urgent surgical decompression under general anesthesia evacuated clots and ligated facial and angular arteries. ICU monitoring ensured airway stability, with discharge on day three with antibiotics and follow-up. Conclusions: This case highlights the rare potential for dental anesthetic injections to cause rapidly progressive hematomas, requiring urgent surgical intervention and multidisciplinary care to prevent airway compromise. Early recognition, imaging, and decisive management are vital in achieving favorable outcomes in such serious complications. Full article

To address the significant problems of high fire risk and low evacuation efficiency in large and complex medical buildings, this study uses Ezhou Hospital as the empirical object to construct a multi-dimensional threat and risk assessment and fire evacuation dynamic coupling model and proposes a systematic optimization scheme to improve personnel evacuation safety. This study proposes an innovative full-chain analysis framework of “threat and risk assessment-dynamic coupling-multi-strategy optimization”. The specific methods employed include the following: (1) Using the probabilistic threat and risk assessment (PRA) method and the risk index (RII) method to identify the most unfavorable scenarios where the fire source is located in the outpatient hall (risk value C2 = 9.86). (2) Combining PyroSim and Pathfinder to construct a dynamic coupling model of fire smoke diffusion and personnel evacuation. Multiple groups, such as patients with mobility problems and rescue personnel, are added to address the limitations of traditional single-factor simulations. (3) Considering the failure of fire shutters, a two-stage optimization strategy is proposed for when the number of personnel is at its peak: the evacuation time is shortened by 23% by using internal intelligent guidance to shunt the congestion node crowd, and the addition of external fire ladders forms a multi-channel coordinated evacuation that further reduces the total evacuation time from 1780 s to 1266 s and improves the efficiency by 29%. The results show that the coupled multi-path coordination strategy and three-dimensional rescue facilities can significantly reduce the bottleneck associated with a single channel. This study provides a multi-dimensional dynamic evaluation framework and comprehensive optimization paradigm for the design of the evacuation of high-rise medical buildings and has important theoretical and technical reference values for improving the fire safety performance of public buildings and the intelligence of emergency management. Full article

Background/Objectives: In 2019, the Italian Constitutional Court (ICC) stated that the principles of equality, dignity, and self-determination enshrined in the constitution require that assisted suicide be considered lawful under certain conditions, including that the patient is kept alive through life-sustaining treatments. In fact, since such patients could already die by refusing treatment, assisted suicide is ethical as it allows them to die more quickly and with dignity. The paper aims to analyze the requirement of life-sustaining treatments from a legal and comparative perspective. Methods: The authors performed the search on Italian legal databases as well as on Scopus and PubMed and by comparing Italian regulations with those of Spain, Portugal, and Austria, which are similar to the Italian one in their fundamentally restrictive nature. The authors have delved into the Italian legal system through an analytical method of interpretation of the normative texts and used the comparative method to investigate which of the legal systems considered is more permissive. Results: According to the ICC, continuing to prohibit assisted suicide for patients who do not require life-sustaining treatments is not discriminatory: these patients cannot be equated with others, as only in the former case does refusing treatment lead to death. From its personalist ethical framework, the ICC also rejected the claim that the patient’s self-determination is being infringed upon: self-determination must be balanced with the protection of life, which is a fundamental value. However, in 2024, the ICC clarified that life-sustaining treatments are not limited to those directly supporting vital functions through medical machines, but also include all treatments without which the person would die in a short time, such as manual bowel evacuation. Conclusions: The current Italian regulation seems inconsistent. It would be preferable to regulate assisted suicide by referencing the models of Spain, Portugal, and Austria. Full article

This paper evaluates the role of federated satellite systems (FSSs) in enhancing unmanned vehicle-supported military medical evacuation (MEDEVAC) missions. An FSS integrates multiple satellite systems, thus improving imaging and communication capabilities compared with standalone satellite systems. A simulation model is developed for a MEDEVAC mission where the FSS control of an unmanned aerial vehicle is distributed across different countries. The model is utilized in a simulation experiment in which the capabilities of the federated and standalone systems in MEDEVAC are compared. The performance of these systems is evaluated by using the most meaningful metrics, i.e., mission duration and data latency, for evacuation to enable life-saving procedures. The simulation results indicate that the FSS, using low-Earth-orbit constellations, outperforms standalone satellite systems. The use of the FSS leads to faster response times for urgent evacuations and low latency for the real-time control of unmanned vehicles, enabling advanced remote medical procedures. These findings suggest that investing in hybrid satellite architectures and fostering international collaboration promote scalability, interoperability, and frequent-imaging opportunities. Such features of satellite systems are vital to enhancing unmanned vehicle-supported MEDEVAC missions in combat zones. Full article

Background: Spontaneous intracerebral hemorrhage (ICH) accounts for approximately 20% of all strokes and is associated with high mortality and disability rates. Despite numerous trials, conventional surgical approaches have not demonstrated consistent improvements in functional outcomes. Minimally invasive surgery (MIS) for ICH evacuation has emerged as a promising alternative, with the potential to improve functional outcomes and reduce mortality. Objectives: This narrative review aims to provide a comprehensive overview of various MIS techniques and their reported impact on functional outcomes in patients with spontaneous ICH while discussing key limitations in the existing literature. Methods: We systematically searched PubMed to identify studies published from 1 January 2010 to 22 March 2024. The search strategy included the following terms: (“minimally*”[All Fields] AND “invasive*”[All Fields] AND “surgery*”[All Fields] AND “intracerebral*”[All Fields] AND “hemorrhage*”[All Fields]) AND (2010:2024[pdat]). This review focuses on randomized controlled trials (RCTs) that evaluate MIS techniques for ICH and their clinical outcomes. Results: Our search identified six RCTs conducted between January 2010 and March 2024, encompassing 2180 patients with a mean age of 58.03 ± 4.5 years. Four trials demonstrated significantly improved functional recovery (mRs ≤ 3), reduced mortality, and fewer adverse events compared with standard medical management or conventional craniotomy. All MIS techniques rely on stereotactic planning and the use of tools such as exoscopes, endoscopes, craniopuncture, or thrombolytic irrigation for precise hematoma evacuation. These approaches reduce brain tissue disruption and improve precision. However, the variability in techniques, costs, and lack of an external validation limit the generalizability of these findings. Conclusions: MIS shows potential as an alternative to conventional management strategies for ICH, offering encouraging evidence for improved functional outcomes and reduced mortality in selected studies. However, these findings remain limited by gaps in the literature, including the need for external validation, significant methodological heterogeneity, and economic challenges. Further rigorous trials are essential to confirm the generalizability and long-term impact of these approaches. Full article

Ultrasound imaging is commonly used for medical triage in both civilian and military emergency medicine sectors. One specific application is the eFAST, or the extended focused assessment with sonography in trauma exam, where pneumothorax, hemothorax, or abdominal hemorrhage injuries are identified. However, the diagnostic accuracy of an eFAST exam depends on obtaining proper scans and making quick interpretation decisions to evacuate casualties or administer necessary interventions. To improve ultrasound interpretation, we developed AI models to identify key anatomical structures at eFAST scan sites, simplifying image acquisition by assisting with proper probe placement. These models plus image interpretation diagnostic models were paired with two real-time eFAST implementations. The first implementation was a manual AI-driven ultrasound eFAST tool that used guidance models to select correct frames prior to making any diagnostic predictions. The second implementation was a robotic imaging platform capable of providing semi-autonomous image acquisition combined with diagnostic image interpretation. We highlight the use of both real-time approaches in a swine injury model and compare their performance of this emergency medicine application. In conclusion, AI can be deployed in real time to provide rapid triage decisions, lowering the skill threshold for ultrasound imaging at or near the point of injury. Full article

Background: Chronic subdural hematoma (CSDH) is increasingly common due to the aging population and widespread use of anticoagulant and antiplatelet medications. The objective of this study is to examine the internal composition of CSDH and explore potential risk factors associated with its recurrence. Methods: This retrospective study analyzed data from 189 patients who underwent surgery in our department between 2014 and 2018. Recorded data included demographics, clinical information, details of surgical interventions, computer tomography (CT) scans, neurological assessments, and follow-up data. The outcome was evaluated clinically and through CT follow-up conducted 4–12 weeks post-surgery. CT scans measured various parameters, including hematoma thickness, hyperdense regions, chronic components, and membrane presence. Results: Patients after the evacuation of CSDH were significantly more common males (66.1%, p > 0.001) had a significantly higher BMI (p < 0.001, 61.6%), arterial hypertension (p < 0.001, 68.3%), and the intake of anticoagulant therapy (p < 0.001, 58%). The recurrence rate was 18.6% after 4 weeks and 2.1% after 8–12 weeks. After uni- and multivariable analysis, the initial hemispheric type (p = 0.019, HR: 3.191; p = 0.012, HR: 3.810) and the increasing preoperative midline shift in CT (p = 0.028, HR: 1.114; p = 0.041, HR: 1.107) were found as independent predictors for recurrence. Overall, outcomes were favorable with a modified Rankin scale (mRS) of 0–2 at discharge (72%), after 4 (89.7%) and 12 (87%) weeks. Conclusion: According to our data, increasing midline shift before surgery and initial hemispheric type of hematoma were independent predictors of recurrence. Most patients achieved an excellent outcome with a low-risk profile. Full article

Background: The subject of this study is intraoperative hypotension during the evacuation of acute subdural haematoma (ASH). We examined the association between the decrease in intraoperative blood pressure (BP) after the induction of anaesthesia and the decrease in BP after opening the dura mater. The second aim of this study was to assess the relationship between preoperative hypertension and the emergence of an intraoperative drop in BP. Methods: This was a retrospective cohort study on adult patients undergoing emergency craniotomy due to ASH. In total, 165 medical records from a 2-year period were analysed. The patients were divided into two groups: high blood pressure (HBP) (n = 89) and normal blood pressure (NBP) (n = 76). The HBP group included patients with hypertension in the preoperative period (systolic blood pressure (SBP) > 150 mmHg). The NBP group included patients with an SBP between 90 and 150 mmHg. Results: We observed a significant drop in blood pressure in two operational periods: after the induction of anaesthesia and after opening the dura mater. A highly relevant positive correlation was noted between the decrease in SBP after anaesthesia induction and the opening of the dura mater (p < 0.001). In the HBP group, after opening the dura mater, there was a 44% SBP decrease from the baseline value. Conclusions: The reduction in BP after the induction of anaesthesia is a predictor of a subsequent drop in BP after opening the dura mater during urgent surgery due to ASH. Patients with hypertension in the preoperative period of ASH tend to have a greater intraoperative drop in BP and worse outcomes. Full article

Wildland firefighters often work in remote settings with multiple hazards that can cause life-threatening injuries. Prompt access to medical care is key to reducing injury consequences. For the last decade, a spatial model of wildland firefighter estimated ground evacuation time (GET) has been used when developing operational response strategies in the contiguous United States (CONUS). This paper describes our updated and improved GET model and the resulting decision support spatial data representing the estimated time to evacuate to a hospital from anywhere within the CONUS using ground transportation only. The new GET model leverages updated input datasets and has improved off-road travel time estimation methods that incorporate the latest science on how terrain slope influences pedestrian travel rates. It also accounts for a novel set of landscape variables not previously considered, including minor roads and trails, streams, woody debris, cliffs, and an improved handling of shrub cover. When compared to a set of recent safety incidents, the reported evacuation times were correlated with the model predictions. The spatial patterns of GET from the new model are similar to the old product; however, we found that, on average, the new version of GET yields slightly faster evacuation times, but with regional variation in this trend. Full article

Medical support in crisis situations is a major challenge. Efficient implementation of the medical evacuation process especially in operations with limited human resources that may occur during armed conflicts can limit the loss of these resources. Proper evacuation of wounded soldiers from the battlefield can increase the chances of their survival and rapid return to further military operations. This paper presents the technical details of the decision support system for medical evacuation to support this process. The basis for the functioning of this system is the continuous measurement of vital signs of soldiers via a specialized measurement module with a set of medical sensors. Vital signs values are then transmitted via the communication module to the analysis and inference module, which automatically determines the color of medical triage and the soldier’s chance of survival. This paper presents the results of tests of our system to validate it, which were carried out using test vectors of soldiers’ vital signs, as well as the results of the system’s performance on a group of volunteers who performed typical activities of tactical operations. The results of this study showed the usefulness of the developed system for supporting military medical services in military operations. Full article

On 1 January 2024, a large earthquake occurred in Japan’s Noto region. Many buildings collapsed as a result of violent shaking. Electricity and water supplies were cut off, and communications were disrupted. On 5 January, four days after the earthquake, we visited Noto and conducted disaster-relief activities. This report integrates and discusses the results of the site visits, information broadcasts by public institutions, and previous research. Evacuation centers lacked water and proper sanitation, leading to health issues, including infectious diseases. Disaster Medical Assistance Teams (DMAT) were delayed in implementing infection control measures. Isolated evacuation centers faced communication and supply challenges. Infrastructure restoration, power supply, and toilet facilities at evacuation centers were delayed because of geographical challenges. It is important to have a team that can determine and carry out the necessary activities on site, even without instructions from the DMAT. It is believed to be effective to decide in advance how volunteer teams and the private sector will conduct their activities, assuming that they will be unable to contact public institutions during a disaster. In large-scale disasters, evacuees must operate evacuation centers autonomously. To achieve this, it is necessary for residents to regularly come together as a community. Systematically recording and accumulating these experiences will contribute to improved disaster prevention and mitigation planning. We hope that the experiences we obtained through the abovementioned disaster will be useful for preparing for future disasters. Full article

Point-of-care ultrasound imaging is a critical tool for patient triage during trauma for diagnosing injuries and prioritizing limited medical evacuation resources. Specifically, an eFAST exam evaluates if there are free fluids in the chest or abdomen but this is only possible if ultrasound scans can be accurately interpreted, a challenge in the pre-hospital setting. In this effort, we evaluated the use of artificial intelligent eFAST image interpretation models. Widely used deep learning model architectures were evaluated as well as Bayesian models optimized for six different diagnostic models: pneumothorax (i) B- or (ii) M-mode, hemothorax (iii) B- or (iv) M-mode, (v) pelvic or bladder abdominal hemorrhage and (vi) right upper quadrant abdominal hemorrhage. Models were trained using images captured in 27 swine. Using a leave-one-subject-out training approach, the MobileNetV2 and DarkNet53 models surpassed 85% accuracy for each M-mode scan site. The different B-mode models performed worse with accuracies between 68% and 74% except for the pelvic hemorrhage model, which only reached 62% accuracy for all model architectures. These results highlight which eFAST scan sites can be easily automated with image interpretation models, while other scan sites, such as the bladder hemorrhage model, will require more robust model development or data augmentation to improve performance. With these additional improvements, the skill threshold for ultrasound-based triage can be reduced, thus expanding its utility in the pre-hospital setting. Full article