Comparison between non-surgical and surgical management of rib fractures in major trauma patients without brain injuries.

Background: This study aimed to evaluate the different outcomes between the non-surgical and surgical groups in patients with major trauma without brain injuries.

Methods: This study prospectively collected data from patients with traumatic rib fractures without brain injuries from June 2017 to November 2019. The primary outcomes were the pain score at admission and discharge and the length of hospital stay.

Original Article: The impacts of DRG payment system on financial balance of multiple trauma: Experiences of three trauma centers in Taiwan.

Introduction: There are concerns regarding the adequacy of applying the diagnosis-related groups (DRG) payment system for multiple traumas (i.e., major diagnostic category 24, MDC-24) patients in Taiwan.

Quality of life outcomes after surgical intervention in patients with multiple rib fractures: A prospective cohort study.

Background: Optimized conservative treatment of rib fractures has long been practiced, but surgical fixation has not been promising until recently. We aimed to examine and analyze immediate postoperative outcomes and 6-month quality of life after injury in patients with moderately severe traumatic rib fractures.

Methods: We conducted a prospective cohort study between July 2017 and June 2019 at the National Taiwan University Hospital.

Hemostatic Enhancement via Chitosan Is Independent of Classical Clotting Pathways-A Quantitative Study.

Hemostasis is a process causing bleeding to stop, and it is known from the literature that hemostasis can be enhanced using chitosan on wound gauzes. We proposed here a continuous flow-through device, with the test blood flowing through the gauze sample at a constant flow rate and the pressure drop across the gauze measured, for assessing the hemostatic performance of the gauze. Experiments were performed using the device with both whole blood and washed blood (with clotting factors and platelets removed from the whole blood), and their results agree with each other within 10% discrepancy, indicating quantitatively that hemostatic enhancement via chitosan is essentially independent of classical clotting pathways, which was demonstrated qualitatively through animal tests in the literature.

Predicting factors for major trauma patient mortality analyzed from trauma registry system.

Objective: We investigated the predictors of mortality in major trauma patients using a trauma registry system database.

Methods: Data were obtained from the trauma registry of a level I trauma center for all patients aged ≥18 years admitted to an intensive care unit (ICU) between January 1, 2006 and December 31, 2013. Models were adjusted for patient demographics, injury mechanism, preexisting comorbidity, Glasgow coma scale (GCS), injury severity score (ISS), emergency department (ED) and ICU procedures, surgical procedures, and complications.

Early Postoperative Endoscopy for Evaluation of the Anastomosis after Esophageal Reconstruction.

Background: Anastomotic leaks significantly affect hospital stay after esophageal surgery. Here, we investigated the efficacy of early endoscopy for predicting anastomotic healing and leaks after esophageal reconstruction.

Methods: A total of 65 consecutive esophageal cancer patients treated by cervical esophagogastrostomy underwent routine endoscopy between postoperative days 5 and 7.

Assessment of the endothelial function with changed volume of brachial artery by menstrual cycle.

Background: The endothelial function has been proven to be an important factor in the pathogenesis of atherosclerosis, hypertension and heart failure. The flow-mediated vasodilation (FMD) of the peripheral artery is an endothelium-dependent function. Brachial-artery ultrasound scanning is the popular method for evaluating FMD.

Effects of moderate exercise on relieving mental load of elementary school teachers.

Long-term endurance exercise could increase activity of parasympathetic nervous and decrease activity of sympathetic nervous at rest. However, previous studies all focused on the effect of endurance training on heart rate variability (HRV) for athletes or sedentary subjects. In Taiwan, elementary school teachers teaching and processing the children's and administrative problems always stand and walk.

Assessment of Stroke Volume From Brachial Blood Pressure Using Arterial Characteristics.

Goal: The goal of this study is to present a modified pulse contour method to estimate the stroke volume (SV) based on an oscillometric sphygmomanometer.

Methods: The pulse contour was extracted from the pulse signal of the cuff pressure. The characteristics of the brachial artery, as well as the compliance ( C(artery)) and time constant τ of the Windkessel model, could be determined and used to estimate the SV once the apparatus finished the blood pressure measurement.

Intrapleural Epinephrine Irrigation for Massive Malignant Hemothorax.

Massive malignant hemothorax (MMH) is a rare and serious complication encountered in the field of oncology and can be life threatening. It is often difficult and complex to manage. Herein, we present cases of four patients who had MMH and in whom a hemothorax was successfully stopped via continuous intrapleural irrigation with epinephrine (5-mg epinephrine/1,000-mL normal saline, infused at 100 mL/h) instead of a conventional surgical approach.

The physical effects of aromatherapy in alleviating work-related stress on elementary school teachers in taiwan.

People use aromatherapy to relieve the symptoms of physical and psychological stress. However, previous studies have not precisely clarified a scientific basis for the beneficial effects of aromatherapy. Therefore, the overall purpose of this study was to elucidate the beneficial effect of aromatherapy in relieving work-related stress.

Intrapleural steroid instillation for multiple organ failure with acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) increases mortality in patients with multiorgan dysfunction syndrome (MODS). This study evaluates the feasibility of intrapleural steroid instillation (IPSI) in patients with ARDS and MODS unresponsive to conventional extracorporeal membrane oxygenation (ECMO). Ninety-two of 467 patients who underwent ECMO between 2005 and 2009 had ARDS, and 30 consecutive adult patients of these 92 patients with severe ARDS and MODS were retrospectively analyzed in this study.

Recombinant factor VIIa use in refractory ulcer bleeding in uremic patient.

Peptic ulcer bleeding is thought to be a major cause of bleeding in patients with end-stage renal disease and is more complicated in uremic patients. We described a 41-year-old man with end-stage renal disease who underwent hemodialysis with refractory ulcer bleeding, failure to all traditional peptic ulcer treatments, and correction of uremic component, who has been successfully treated by using recombinant factor VIIa. There have been few case reports in dealing refractory upper gastrointestinal bleeding in uremic patients in the literature; and in this case report, we demonstrates that recombinant factor VIIa could be used as a rescue therapy in these high–surgical risk patients when medical therapy fails.

Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury.

Introduction: Sepsis is the leading cause of acute kidney injury (AKI) in critical patients. The optimal timing of initiating renal replacement therapy (RRT) in septic AKI patients remains controversial. The objective of this study is to determine the impact of early or late initiation of RRT, as defined using the simplified RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal failure) classification (sRIFLE), on hospital mortality among septic AKI patients.

High APACHE II score and long length of bowel resection impair the outcomes in patients with necrotic bowel induced hepatic portal venous gas.

Background: Hepatic portal venous gas (HPVG) is a rare but potentially lethal condition, especially when it results from intestinal ischemia. Since the literatures regarding the prognostic factors of HPVG are still scarce, we aimed to investigate the risk factor of perioperative mortality in this study.

Methods: We analyzed data for patients with intestinal ischemia induced HPVG by chart review in our hospital between 2000 and 2007.

Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney injury after major abdominal surgery.

Introduction: Abdominal surgery is probably associated with more likelihood to cause acute kidney injury (AKI). The aim of this study was to evaluate whether early or late start of renal replacement therapy (RRT) defined by simplified RIFLE (sRIFLE) classification in AKI patients after major abdominal surgery will affect outcome.

Methods: A multicenter prospective observational study based on the NSARF (National Taiwan University Surgical ICU Associated Renal Failure) Study Group database.

A novel surgical technique: gasless laparoscopy-assisted gastrojejunostomy.

Gastrojejunostomy is often performed to relieve the symptoms of gastric outlet obstruction. The recent trend is toward minimally-invasive procedures to reduce recovery time and increase quality of life. However, several problems and complications have been reported using gas-filled laparoscopy, especially in the elderly and patients with poor cardiopulmonary function.