Explore the vast range of titles available.

IntroductionEffective haemorrhage control is crucial in cases of limb trauma involving arterial injury, such as shark attacks, to prevent potentially fatal outcomes. International first aid consensus recommends the use of arterial tourniquets (proprietary or makeshift) as a primary treatment for life-threatening external bleeding. Manual pressure applied directly over a major artery proximal to the injury, such as inguinal fist compression (IFC), is more accessible in a first-aid situation, but is currently not recommended due to limited evidence. The purpose of this study is to determine whether the application of IFC is superior to commercial windlass tourniquets (CWTs) in reducing blood flow in the femoral artery when performed by untrained bystanders.Methods and analysisStopping Haemorrhage by Application of Randomised Compression or Tourniquet (SHARC-2) is a superiority, assessor-blinded, cross-over, randomised controlled trial conducted with healthy untrained adult volunteers in non-clinical settings. Participants will be rotated as providers and recipients of both IFC and CWT, with providers randomised to the order that they perform the techniques. Providers will be exposed to an educational infographic before applying that technique to a recipient behind a drop sheet. A sonographer, blinded to the technique, will measure the peak systolic velocity of blood flow in the superficial femoral artery using Doppler ultrasound at baseline and then during application of each technique for 5 min. The mean percentage reduction in peak systolic velocity will be compared between IFC and CWT groups.Ethics and disseminationEthics approval for this study was granted by the Bond University Human Research Ethics Committee (BUHREC JF01036) on 23 January 2023. All participants will be provided with written informed consent prior to enrolment and the trial will involve healthy adult volunteers. To minimise risk, preintervention screening, sonographic assessment and postintervention follow-up will be implemented with adverse events monitored and reported in accordance with HREC guidelines. Results will be disseminated through peer-reviewed journals, academic conferences, local resuscitation forums and public health education initiatives. A lay summary will also be shared with relevant community groups and via social media platforms to enhance public accessibility.Trial registration numberACTRN12624001054505.

BackgroundIatrogenic vascular injury as a result of closed hip nailing is not common, but is a regularly reported complication after hip fracture surgeries.MethodsTo prevent vascular injury in closed hip nailing by identifying the range of distances and angles between deep and superficial femoral arteries (DFAs and SFAs) and distal screws.Patients and methodsForty subjects who underwent computed tomography angiographies were included in this study. Imaginary lines marking the distal screws (proximal femoral nail antirotation-II [PFNA-II], 180 and 300 mm; inter-trochanteric/sub-trochanteric nails [ITST], 200 and 300 mm) were drawn on the scout film. On arterial phase images, angles between distal screw lines and those marking DFAs or SFAs, as well as the distance between each artery and far cortex, were measured using the cross-reference capabilities of the picture archiving and communication system.ResultsThe short nails (PFNA-II 200 mm and ITST 180 mm) were closest to the DFAs, indicating that these nails are most likely to cause injury (PFNA-II 200 mm: 11.2 ± 13.7° anterior and 9.87 ± 5.83 mm; ITST 180 mm: 22.56 ± 15.92° posterior and 9.24 ± 4.74 mm). The short nails were relatively distant from the SFAs, which were located posteriorly to the long nails (PFNA-II 300 mm and ITST 300 mm).ConclusionsThese data indicate that insertion of distal screws into intramedullary nails increases the risk of injury to vascular structures. Surgeons must take care in drilling or inserting screws to ensure the prevention of vascular injury.

Background Iatrogenic vascular injuries during varicose vein surgery are serious. The aim of this study was to investigate their nature and consequences. Method A systematic literature research was performed. Results The incidence is low (0.0017%–0.3%). We found 81 patients suffering from 87 vascular injuries—44 arterial and 43 deep vein injuries. Conclusion Vascular injuries during varicose surgery are rare but serious. They are avoidable, and when they occur, early recognition is crucial. Bleeding is a common symptom, especially in deep venous injury. In our study, we reviewed the literature on 81 patients with 87 vascular injuries. Laceration or division of the femoral vein dominated venous injuries (28/43). Partial stripping of the femoral vein was not common (4/43) and occurred when the strip probe passed into the deep veins through a perforator. Arterial stripping predominated in arterial injuries (17/44) and happened when stripping distally during a primary operation, as reported by experienced surgeons, in nonobese women. Major arterial complications resulted in ischemia, often with diagnostic delay and poor reconstruction results. Only 30% (13/44) of arterial injuries were detected peroperatively. The amputation rate was 34% (15/44), but rose to 100% if combined with intra‐arterial sclerotherapy (5/5 cases). When stripping an artery below the femoral artery, the amputation rate was high (42%; 5/12) and morbidity severe (85%; 11/12). All fatal injuries (5 cases) were venous. Anatomic knowledge and awareness of the possibility of vascular complications should be preventive. Early detection by routine checking of arterial circulation is important.

Background Arterial injury caused by heterotopic ossification (HO) following fractures is rarely reported, yet it can have catastrophic consequences. This case report presents a unique instance of femoral artery injury and hematoma organization, occurring a decade after intramedullary nail fixation for a femoral shaft fracture complicated by HO. Case presentation A 56-year-old male presented with right femoral artery injury and organized hematoma, a decade after suffering bilateral femoral shaft fractures with mild head injury in a traffic accident. He had received intramedullary nailing for the right femoral shaft fracture and plate fixation for the left side in a local hospital. Physical examination revealed two firm, palpable masses with clear boundaries, limited mobility, and no tenderness. Peripheral arterial pulses were intact. Radiography demonstrated satisfactory fracture healing, while a continuous high-density shadow was evident along the inner and posterior aspect of the right thigh. Computed tomography angiography identified a large mixed-density mass (16.8 × 14.8 × 20.7 cm) on the right thigh’s medial side, featuring central calcification and multiple internal calcifications. The right deep femoral artery coursed within this mass, with a smaller lesion noted on the posterior thigh. Surgical consultation with a vascular surgeon led to planned intervention. The smaller mass was completely excised, but the larger one partially, as it encased the femoral artery. The inability to remove all HO was due to excessive bleeding. Postoperatively, the patient experienced no complications, and one-year follow-up revealed a favorable recovery with restoration of full right lower limb mobility. Conclusion This case underscores the potential gravity of vascular injury associated with heterotopic ossification. Surgeons should remain vigilant regarding the risk of vascular injury during HO excision.

Current hemostatic fabric often encounters the issue of blood seeping or leaking through the fabric and at the junctions between the fabric and tissue, leading to extra blood loss. Herein, we report a hemostatic nanofabric composed of anionic and cationic nanofibers. Upon contact with wound, the porous nanofabric can absorb the interfacial blood and self-seal to form a compact physical barrier through interfiber bonding, preventing blood from longitudinally penetrating the fabric. This process results in the encapsulation of blood components within the electrostatically crosslinked nanofiber network, creating a robust thrombus that reinforces the physical barrier. Moreover, this nanofabric exhibits strong tissue adhesiveness, inhibiting blood seeping out at the seam of the fabric and tissue. Its hemostatic performance in animal injuries surpasses that of standard cotton gauze and Combat Gauze TM . In the pig femoral artery injury, the blood loss from the nanofabric is only ca. 8% of that from Combat Gauze TM . The nanofabric exhibits excellent biodegradability, hemocompatibility, cytocompatibility, antibacterial activity, and wound healing promotion. Seepage can be an issue in haemostatic dressings. Here, the authors combine anionic and cationic nanofibers, which can absorb surface blood and form a seal, encapsulating blood components and forming a rapid thrombus while remaining biocompatibility and biodegradation properties.

Achieving rapid definitive hemostasis is essential to ensure survival of patients with massive bleeding in pre-hospital care. It is however challenging to develop hemostatic agents or dressings that simultaneously deliver a fast, long-lasting and safe treatment of hemorrhage. Here, we integrate meso-/micro-porosity, blood coagulation and stability into a flexible zeolite-cotton hybrid hemostat. We employ an on-site template-free growth route that tightly binds mesoporous single-crystal chabazite zeolite onto the surface of cotton fibers. This hemostatic material maintains high procoagulant activity after water flow treatment. Chabazite particles are firmly anchored onto the cotton surface with < 1% leaching after 10 min of sonication. The as-synthesized hemostatic device has superior hemostatic performance over most other clay or zeolite-based inorganic hemostats, in terms of higher procoagulant activity, minimized loss of active components and better scalability for practical applications (a hemostatic T-shirt is hereby demonstrated as an example). Zeolites have attracted attention and have been applied as haemostatic agents; however, there are issues associated with released zeolite powder. Here, the authors report on the growth of zeolites on cotton fibres with high stability and haemostatic ability.

Restenosis driven by intimal hyperplasia remains a major limitation of peripheral arterial intervention. Photodynamic therapy (PDT) using porfimer sodium (Photofrin®) demonstrated promising preclinical efficacy in the 1990s; however, its translation into clinical vascular practice has been stalled. We reappraised a historical pilot dataset to evaluate both biological efficacy and procedural feasibility. In a rabbit model of bilateral femoral artery balloon injury (10 animals initiated), one artery per animal received intraluminal PDT (630 nm, ~ 5.6 J/cm²) 48 h after intramuscular porfimer sodium administration (2 mg/kg), while the contralateral artery served as an internal control. Histomorphometric analysis of the intima-media ratio (IMR) was performed 21 days after injury. The procedural feasibility of this approach is severely limited. Only three of the ten animals yielded analyzable paired arterial samples because of high intraoperative mortality (40%) and postoperative complications. In surviving animals, PDT-treated arteries demonstrated a consistent and marked suppression of neointimal hyperplasia compared with controls (IMR 0.29 ± 0.07 vs. 1.65 ± 0.55; P < 0.001), corresponding to a median IMR reduction of 82%. This reappraisal confirms the potent biological effects of porfimer sodium-mediated PDT on neointimal hyperplasia. However, the principal contribution of this study lies in the transparent documentation of critical translational barriers, particularly the unsustainable procedural mortality associated with this model of bilateral injury. By providing detailed dosimetry parameters and a candid feasibility analysis, this study offers methodological insights to guide the design of safer and more translatable preclinical vascular PDT studies in the future.

We have shown that both insulin and resveratrol (RSV) decrease neointimal hyperplasia in chow-fed rodents via mechanisms that are in part overlapping and involve the activation of endothelial nitric oxide synthase (eNOS). However, this vasculoprotective effect of insulin is abolished in high-fat-fed insulin-resistant rats. Since RSV, in addition to increasing insulin sensitivity, can activate eNOS via pathways that are independent of insulin signaling, such as the activation of sirtuin 1 (SIRT1) and AMP-activated kinase (AMPK), we speculated that unlike insulin, the vasculoprotective effect of RSV would be retained in high-fat-fed rats. We found that high-fat feeding decreased insulin sensitivity and increased neointimal area and that RSV improved insulin sensitivity (p < 0.05) and decreased neointimal area in high-fat-fed rats (p < 0.05). We investigated the role of SIRT1 in the effect of RSV using two genetic mouse models. We found that RSV decreased neointimal area in high-fat-fed wild-type mice (p < 0.05), an effect that was retained in mice with catalytically inactive SIRT1 (p < 0.05) and in heterozygous SIRT1-null mice. In contrast, the effect of RSV was abolished in AMKPα2-null mice. Thus, RSV decreased neointimal hyperplasia after arterial injury in both high-fat-fed rats and mice, an effect likely not mediated by SIRT1 but by AMPKα2.

Introduction Femoral nerve palsy and femoral artery injury are serious complications of total hip arthroplasty. However, few studies have compared the anatomical positions of these structures in different patient positions. This study aimed to compare the anatomical positions of the femoral nerve and artery in the lateral and supine positions. Materials and methods This multicenter retrospective study included 111 patients who underwent lateral and supine computed tomography (CT) from 2016 to 2023. CT images were reconstructed in the anterior pelvic plane. The horizontal distance from the anterior margin of the acetabulum to the femoral nerve (Distance N) and femoral artery (Distance A) was measured. The difference in Distance N between the two positions (ΔLateral–supine Distance N) was calculated by subtracting the supine value from the lateral value. Results The average Distance N was 26.5 ± 5.1 mm in the lateral position and 21.1 ± 4.4 mm in the supine position, with the nerve located significantly closer to the acetabulum in the supine position (P < 0.001). Similarly, the average Distance A was 26.8 ± 5.4 mm in the lateral position and 20.4 ± 4.9 mm in the supine position (P < 0.001). Multiple regression analysis showed that Distance N in the lateral position was significantly shorter in female patients and those with low body weight. In addition, low body weight correlated with a smaller ΔLateral–supine Distance N. Conclusions The femoral nerve and artery are located closer to the anterior margin of the acetabulum in the supine position than in the lateral position. Low body weight was an independent predictor of shorter Distance N in both positions and a smaller ΔLateral–supine Distance N. These findings underscore the importance of considering patient positioning during total hip arthroplasty, particularly in patients with low body weight, to reduce neurovascular risks.

Sealing of puncture points subsequent to interventional surgeries is a vital requirement for all interventional operations. Currently, large-diameter sheaths and transapical punctures present a significant challenge for wound closure, with a high probability of failure. In this study, we’ve developed a water-activated tissue adhesive patch (WAP) designed for quick and strong adhesion to blood vessel and heart tissue surfaces after surgery. This patch consists of a polyethylene glycol (PEG) derivative coating and a gelatin sponge. Upon contact with a vascular or cardiac wound, the PEG derivative coating quickly absorbs water, dissolves, undergoes rapid crosslinking, and adheres to the tissue surface. This patch can endure a burst pressure more than 300 mmHg and exhibits good biosafety, thereby ensuring effective wound closure and healing. Animal studies have demonstrated that the patch effectively closes wounds and rapidly achieves hemostasis through simple adhesion. This has been exemplified in male porcine models, including heart stab wounds, femoral artery punctures using a 14 Fr sheath, and abdominal aorta punctures with a 20 Fr sheath. Follow-up evaluations indicate favorable postoperative wound healing. When paired with a suitable delivery device, the WAP stands as a potent candidate for the next generation of vascular and transapical closure device. Sealing of puncture points after interventional surgeries is a vital requirement, but large diameter sheaths and transapical punctures present a significant challenge for wound closure. Here, the authors present a water-activated tissue adhesive patch designed for quick and strong adhesion to blood vessel and heart tissue surfaces after surgery.