BACKGROUND & AIMS: :Posttraumatic stress disorder (PTSD) and depressive symptoms have been theorized to mediate the relationship between trauma exposure and physical health symptoms. Although empirical evidence supports this premise, studies conducted to date have employed statistical mediation analyses that are now broadly criticized. Furthermore, the mediating roles of both PTSD and depressive symptoms have seldom been examined concurrently, and it remains unclear which PTSD symptom clusters uniquely mediate this relationship. The aim of the present study was to examine the mediating role of reexperiencing, avoidance/numbing, hyperarousal, and depressive symptoms in the relationship between trauma exposure and physical health symptoms. Participants were 516 Spanish female undergraduate students. Physical health symptoms were compared between those who reported trauma exposure (n = 266) and those who did not (n = 250). Data from trauma-exposed participants were analyzed using regression models with bootstrapping to test mediation. Results of the analyses showed that the trauma-exposed group reported significantly more physical health symptoms (r(2) = .035). Hyperarousal and depressive symptoms uniquely mediated the relationship between trauma exposure and physical health symptoms. Our findings clarify some of the mechanisms by which negative health consequences occur subsequent to trauma exposure.

背景与目标： : 创伤后应激障碍 (PTSD) 和抑郁症状已被理论化，以介导创伤暴露与身体健康症状之间的关系。尽管经验证据支持这一前提，但迄今为止进行的研究采用了统计中介分析，这些分析现在受到广泛批评。此外，很少同时检查PTSD和抑郁症状的中介作用，并且尚不清楚哪些PTSD症状簇唯一地介导了这种关系。本研究的目的是研究再经历，回避/麻木，过度觉醒和抑郁症状在创伤暴露与身体健康症状之间的关系中的中介作用。参与者是516名西班牙女本科生。在报告创伤暴露的患者 (n = 266) 和未报告创伤暴露的患者 (n = 250) 之间比较了身体健康症状。使用回归模型和自举测试中介来分析创伤暴露参与者的数据。分析结果表明，创伤暴露组报告了更多的身体健康症状 (r(2) = .035)。过度觉醒和抑郁症状独特地介导了创伤暴露与身体健康症状之间的关系。我们的发现阐明了创伤暴露后产生负面健康后果的一些机制。

BACKGROUND & AIMS: STUDY OBJECTIVE:We determine the effect of the duration of emergency department (ED) observation on computed tomography (CT) rate for children with minor blunt head trauma. METHODS:We performed a prospective cohort study of children with blunt head trauma and a Glasgow Coma Scale score greater than 14. We defined time from injury as the time from head injury to initial physician (emergency attending physician or fellow) assessment. For children who were observed in the ED before CT decisionmaking, we defined ED observation time as time from initial physician assessment to the decision whether to obtain a CT. After adjusting for time from injury, patient age, sex, physician type, and study month, we measured the effect of ED observation time on CT rate in each of the 3 Pediatric Emergency Care Applied Research Network Traumatic Brain Injury risk groups. RESULTS:Of the 1,605 eligible patients, we enrolled 1,381 (86%). Of the enrolled patients, 676 (49%) were observed in the ED and 272 (20%) had a CT performed. After adjustment, every hour of ED observation time was associated with a decrease in CT rate for children in all 3 traumatic brain injury risk groups: high risk (adjusted odds ratio [OR] 0.11; 95% confidence interval [CI] 0.05 to 0.24), intermediate risk (adjusted OR 0.28; 95% CI 0.21 to 0.36), and low risk (adjusted OR 0.47; 95% CI 0.31 to 0.73). All 8 children with a significant traumatic brain injury had an immediate CT. CONCLUSION:For children with minor blunt head trauma, ED observation time was associated with a time-dependent reduction in cranial CT rate, with no delay in the diagnosis of a significant traumatic brain injury.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The utility of esophagogastroduodenoscopy (EGD) performed at the time of percutaneous endoscopic gastrostomy (PEG) is unclear. We examined whether EGD at time of PEG yielded clinically useful information important in patient care. We also reviewed the outcome and complication rates of EGD-PEG performed by trauma surgeons. METHODS:Retrospective review of all trauma patients undergoing EGD with PEG at a level I trauma center from 1/01-6/03. RESULTS:210 patients underwent combined EGD with PEG by the trauma team. A total of 37% of patients had unsuspected upper gastrointestinal lesions seen on EGD. Of these, 35% had traumatic brain injury, 10% suffered multisystem injury, and 47% had spinal cord injury. These included 15 esophageal, 61 gastric, and six duodenal lesions, mucosal or hemorrhagic findings on EGD. This finding led to a change in therapy in 90% of patients; either resumption/continuation of H2 -blockers or conversion to proton-pump inhibitors. One patient suffered an upper gastrointestinal bleed while on H2-blocker. It was treated endoscopically. Complication rates were low. There were no iatrogenic visceral perforations seen. Three PEGs were inadvertently removed by the patient (1.5%); one was replaced with a Foley, one replaced endoscopically, and one patient underwent gastric repair and open jejunostomy tube. One PEG leak was repaired during exploration for unrelated hemorrhage. Six patients had significant site infections (3%); four treated with local drainage and antibiotics, one requiring operative debridement and later closure, and one with antibiotics alone. CONCLUSION:EGD at the time of PEG may add clinically useful data in the management of trauma patients. Only one patient treated with acid suppression therapy for EGD diagnosed lesions suffered delayed gastrointestinal bleeding. Trauma surgeons can perform EGD and PEG with acceptable outcomes and complication rates.

背景与目标：

BACKGROUND & AIMS: :We analysed the trauma triage system at a specific level I trauma centre to assess rates of over- and undertriage and to support recommendations for system improvements. The triage process is designed to estimate the severity of patient injury and allocate resources accordingly, with potential errors of overestimation (overtriage) consuming excess resources and underestimation (undertriage) potentially leading to medical errors.We first modelled the overall trauma system using risk analysis methods to understand interdependencies among the actions of the participants. We interviewed six experienced trauma surgeons to obtain their expert opinion of the over- and undertriage rates occurring in the trauma centre. We then assessed actual over- and undertriage rates in a random sample of 86 trauma cases collected over a six-week period at the same centre. We employed Bayesian analysis to quantitatively combine the data with the prior probabilities derived from expert opinion in order to obtain posterior distributions. The results were estimates of overtriage and undertriage in 16.1 and 4.9% of patients, respectively. This Bayesian approach, which provides a quantitative assessment of the error rates using both case data and expert opinion, provides a rational means of obtaining a best estimate of the system's performance. The overall approach that we describe in this paper can be employed more widely to analyse complex health care delivery systems, with the objective of reduced errors, patient risk and excess costs.

背景与目标： : 我们在特定的I级创伤中心分析了创伤分类系统，以评估过度和不足分类的发生率，并支持有关系统改进的建议。分类过程旨在估计患者伤害的严重程度并相应地分配资源，其中潜在的高估错误 (overtriage) 消耗了多余的资源，而低估 (undertriage) 则可能导致医疗错误。我们首先使用风险分析方法对整个创伤系统进行建模，以了解参与者行为之间的相互依赖性。我们采访了六位经验丰富的创伤外科医生，以获取他们对创伤中心发生的过度和漏诊率的专家意见。然后，我们评估了在同一中心六周内收集的86例创伤病例的随机样本中的实际分流率和分流不足率。我们采用贝叶斯分析将数据与从专家意见得出的先验概率定量结合，以获得后验分布。结果分别是16.1和4.9% 患者的超分流和不足分流的估计值。这种贝叶斯方法可以使用案例数据和专家意见对错误率进行定量评估，从而提供了一种合理的方法来获得系统性能的最佳估计。我们在本文中描述的总体方法可以更广泛地用于分析复杂的医疗保健提供系统，目的是减少错误，患者风险和超额成本。

BACKGROUND & AIMS: PURPOSE:The purpose of this study is to examine the effect of establishing a dedicated operating room for unscheduled orthopedic cases and to evaluate a group of patients with isolated femur fractures. The frequency of after-hours surgery and the impact of patients who present with acute orthopedic injuries are reviewed. METHODS:A retrospective review of all orthopedic cases from the operating room scheduling system at a level-one trauma center was undertaken from October 2003 to September 2005. Before October 2004, unscheduled cases were placed on a shared add-on list, and no special priority was given to orthopedic cases. Additionally, a subset of adult patients with isolated femoral shaft fractures was identified to evaluate time from admission to surgery, operative time, frequency of transfer of care between surgeons, and total length of hospital stay. RESULTS:The number of orthopedic cases was 1799 in fiscal year 2004 (FY04) and 2046 in FY05, an increase of 14%. Overall, the hospital experienced an increase in level-one trauma activations from 1450 in FY04 to 1580 in FY05 (8.2%), and an increase in the number operative trauma cases from 447 to 494 (9.5%). Cases after 7:00 pm declined from 197 in FY04 to 165 in FY05, a decrease of 16%. Cases between midnight and 7:00 am declined from 63 in FY04 to 35 in FY05, a decrease of 44%. For the subset of femur fracture patients, transfer of care to another operating surgeon occurred 4.5 times more frequently. The median delay between admission and surgery increased from 5.7 hours to 10.9 hours. Median case duration increased from 106 to 127 minutes. CONCLUSIONS:It is possible to dramatically decrease the occurrence of after-hours orthopedic surgery in a level-one trauma center through the use of a dedicated room for unscheduled orthopedic trauma cases. Benefits include less frequent activation of after-hours operating room resources, fewer disruptions to the OR schedule and office hours, and more frequent fracture care by orthopedic traumatologists. The impact of a longer delay between admission and surgical treatment and more frequent transfer of care between surgeons deserves further evaluation.

背景与目标：

BACKGROUND & AIMS: :External laryngeal trauma is rare, accounting for less than 1% of all trauma cases seen at major centers. We report the case of a man who experienced multiple injuries, including an external laryngeal trauma. The primary signs and symptoms of his laryngeal trauma were hoarseness, hemoptysis, the loss of his laryngeal prominence (Adam's apple), neck tenderness, traumatic emphysema in the neck, and a small penetrating wound to the right of the laryngeal prominence. The patient underwent immediate tracheostomy and surgical exploration. On long-term followup, his voice quality and airway patency improved. This case illustrates the importance of rapid identification and early management of laryngotracheal trauma in a patient with multiple injuries.

背景与目标： : 喉外创伤很少见，占主要中心所有创伤病例的不到1%。我们报告了一名男子遭受多处伤害，包括喉部外部创伤的情况。喉部创伤的主要体征和症状是声音嘶哑，咯血，喉部突出 (亚当的苹果) 的丧失，颈部压痛，颈部外伤性肺气肿以及喉部突出右侧的小穿透伤口。患者立即接受气管切开术和手术探查。在长期随访中，他的声音质量和气道通畅性得到改善。该病例说明了在多发伤患者中快速识别和早期处理喉气管创伤的重要性。

BACKGROUND & AIMS: :This study used resting-state functional magnetic resonance imaging (fMRI) to investigate whether functional connectivity is altered in people developing post-traumatic stress disorder (PTSD) following recent trauma. Sixty-two participants who had experienced recent acute traumatic events underwent a 7.3 min resting fMRI scan within 2 days post accident. Of these, 22 participants were diagnosed with PTSD within 1 to 6 months. Nineteen age- and sex-matched subjects without PTSD were selected as the trauma-exposed control group. Posterior cingulate cortex connectivity was determined from 17 PTSD patients and 15 control subjects by investigating synchronic low-frequency fMRI signal fluctuations using a temporal correlation method. To assess the relationship between PTSD symptom severity and PCC connectivity, the contrast image representing areas correlated with the PCC was correlated with the 17 PTSD subjects' Clinician Administered PTSD Scale (CAPS) scores at diagnosis. Compared with the control group, PTSD patients exhibited decreased functional connectivity in the right lingual and right middle temporal gyri, and left lingual/posterior cingulate cortex. The left inferior temporal gyrus, right middle temporal gyrus, left middle temporal gyrus/insula, left medial frontal lobe/anterior cingulate cortex, and right medial frontal gyrus also showed increased connectivity within two days post accident. A negative correlation was found between PCC connectivity and CAPS scores in the left medial prefrontal cortex (mPFC). These results suggest that patients who develop PTSD exhibit different resting-state patterns of neuronal activity following recent trauma. Abnormal FC of mPFC may be a major risk factor predisposing patients to the development of PTSD.

背景与目标： : 这项研究使用静息状态功能磁共振成像 (fMRI) 来调查最近发生创伤后发生创伤后应激障碍 (PTSD) 的人的功能连接是否发生改变。62名最近经历过急性创伤事件的参与者在事故发生后2天内接受了7.3分钟的静息fMRI扫描。其中，22名参与者在1至6个月内被诊断出患有PTSD。选择19名年龄和性别匹配的无PTSD受试者作为创伤暴露对照组。通过使用时间相关方法调查共时低频fMRI信号波动，确定了17名PTSD患者和15名对照受试者的后扣带回皮层连通性。为了评估PTSD症状严重程度与PCC连通性之间的关系，将代表与PCC相关区域的对比图像与17名PTSD受试者的临床医生在诊断时给予的PTSD量表 (CAPS) 评分相关。与对照组相比，PTSD患者的右舌和右中颞回以及左舌/后扣带回皮质的功能连接降低。事故发生后两天内，左侧颞下回，右侧颞下回，左侧颞下回/岛叶，左侧内侧额叶/前扣带回和右侧内侧额叶也显示连接增加。在左侧内侧前额叶皮层 (mPFC) 的PCC连通性与CAPS评分之间发现负相关。这些结果表明，发生PTSD的患者在最近的创伤后表现出不同的静息状态神经元活动模式。mPFC的FC异常可能是导致患者发生PTSD的主要危险因素。

BACKGROUND & AIMS: :The endogenous sex steroids, testosterone and beta-estradiol, play a major role in inflammatory processes. They regulate several cytokine genes by interaction with their intracellular receptors that are, essentially, transcription factors. Because T-lymphocyte functions are altered following trauma-hemorrhage in male mice, we investigated whether (i) receptors for androgen (AR) and estrogen (ER) are present in splenic T lymphocytes, (ii) receptor expressions are altered following trauma-hemorrhage, and (iii) pretreatment of male mice with the AR antagonist, flutamide, alters receptor expressions and IL-6 release. Analysis of nuclear extracts indicated the presence of AR and ER in splenic T lymphocytes. No difference in receptor expressions between males and females or following trauma-hemorrhage was observed. Pretreatment of males with flutamide, however, led to increased ER expression in T lymphocytes of sham and trauma-hemorrhaged animals. This suggested that flutamide is capable of inducing the expression of another receptor belonging to a different gonadal steroid. Because response elements for AR and ER are present in the promoter region of the IL-6 gene, release of IL-6 and expression of signal transducer and activator of transcription 3 (STAT3) were analyzed as functional parameters in splenic T lymphocytes. Trauma-hemorrhage decreased IL-6 release by T lymphocytes and the release was restored to sham levels with flutamide pre-treatment. Similarly, STAT3 expression was decreased in T lymphocytes following trauma-hemorrhage and the expression was restored by flutamide pre-treatment. These data collectively demonstrate the importance of gonadal steroids in the regulation of splenic T-lymphocyte functions.

背景与目标： : 内源性类固醇，睾丸激素和 β-雌二醇在炎症过程中起主要作用。它们通过与细胞内受体 (本质上是转录因子) 相互作用来调节几种细胞因子基因。由于雄性小鼠创伤出血后T淋巴细胞功能改变，我们研究了 (i) 脾T淋巴细胞中是否存在雄激素 (AR) 和雌激素 (ER) 受体，(ii) 创伤出血后受体表达改变，(iii) 用AR拮抗剂氟他胺预处理雄性小鼠，改变受体表达和IL-6释放。核提取物分析表明脾T淋巴细胞中存在AR和ER。在男性和女性之间或在创伤出血后未观察到受体表达的差异。然而，用氟他胺对男性进行预处理会导致假手术和创伤出血动物的T淋巴细胞中ER表达增加。这表明氟他胺能够诱导另一种属于不同性腺类固醇的受体的表达。由于AR和ER的反应元件存在于IL-6基因的启动子区域，因此分析了IL-6的释放以及信号转导和转录激活子3 (STAT3) 的表达作为脾T淋巴细胞的功能参数。创伤-出血减少了T淋巴细胞的IL-6释放，并通过氟他胺预处理将释放恢复到假水平。同样，创伤出血后T淋巴细胞中STAT3表达降低，并且通过氟他胺预处理恢复了该表达。这些数据共同证明了性腺类固醇在调节脾T淋巴细胞功能中的重要性。

BACKGROUND & AIMS: :This investigation examined differences in symptom patterns of two different trauma samples using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). MMPI-2s of 122 male combat veterans seeking outpatient treatment for combat-related PTSD were compared with those of 64 PTSD-diagnosed adults seeking outpatient treatment for the effects of child sexual abuse (CSA). We examined variables related to degree of health concerns, depression, somatization, anger and hostility, masculine-feminine traits, paranoid ideation, anxiety, difficulties thinking and concentrating, elevated mood, and social introversion, as well as test-taking attitude. MANOVAs revealed between-group differences on several variables. However, when analyses controlled for the effect of age, nearly all differences disappeared; the only remaining difference was in a scale measuring anger. Thus, it appears CSA survivors and combat veterans are much more similar than different in their clinical presentation on the MMPI-2. Conceptual issues in the assessment of PTSD are discussed.

背景与目标： : 这项调查使用明尼苏达州多相人格量表-2 (MMPI-2) 检查了两种不同创伤样本的症状模式差异。将122名寻求与战斗相关的PTSD进行门诊治疗的男性战斗退伍军人的MMPI-2s与64名经PTSD诊断为儿童性虐待 (CSA) 的门诊治疗的成年人进行了比较。我们研究了与健康问题程度，抑郁，躯体化，愤怒和敌意，男性女性特征，偏执观念，焦虑，思考和集中注意力的困难，情绪低落，社交内向以及应试态度有关的变量。MANOVAs揭示了几个变量的组间差异。但是，当分析控制了年龄的影响时，几乎所有差异都消失了。唯一剩下的差异是衡量愤怒的量表。因此，看来CSA幸存者和战斗退伍军人在MMPI-2上的临床表现要相似得多。讨论了PTSD评估中的概念问题。

BACKGROUND & AIMS: HYPOTHESIS:Discrepancies exist in complications and outcomes at teaching trauma centers (TTCs) vs nonteaching TCs (NTCs). DESIGN:Retrospective review of the National Trauma Data Bank research data sets (January 1, 2007, through December 31, 2008). SETTING:Level II TCs. PATIENTS:Patients at TTCs were compared with patients at NTCs using demographic, clinical, and outcome data. Regression modeling was used to adjust for confounding factors to determine the effect of house staff presence on failure to rescue, defined as mortality after an in-house complication. MAIN OUTCOME MEASURES:The primary outcome measures were major complications, in-hospital mortality, and failure to rescue. RESULTS:In total, 162 687 patients were available for analysis, 36 713 of whom (22.6%) were admitted to NTCs. Compared with patients admitted to TTCs, patients admitted to NTCs were older (52.8 vs 50.7 years), had more severe head injuries (8.3% vs 7.8%), and were more likely to undergo immediate operation (15.0% vs 13.2%) or ICU admission (28.1% vs 22.8%) (P < .01 for all). The mean Injury Severity Scores were similar between the groups (10.1 for patients admitted to NTCs vs 10.4 for patients admitted to TTCs, P < .01). Compared with patients admitted to TTCs, patients admitted to NTCs experienced fewer complications (adjusted odds ratio [aOR], 0.63; P < .01), had a lower adjusted mortality rate (aOR, 0.87; P = .01), and were less likely to experience failure to rescue (aOR, 0.81; P = .01). CONCLUSIONS:Admission to level II TTCs is associated with an increased risk for major complications and a higher rate of failure to rescue compared with admission to level II NTCs. Further investigation of the differences in care provided by level II TTCs vs NTCs may identify areas for improvement in residency training and processes of care.

背景与目标：

BACKGROUND & AIMS: :The cervical collar has been routinely used for trauma patients for more than 30 years and is a hallmark of state-of-the-art prehospital trauma care. However, the existing evidence for this practice is limited: Randomized, controlled trials are largely missing, and there are uncertain effects on mortality, neurological injury, and spinal stability. Even more concerning, there is a growing body of evidence and opinion against the use of collars. It has been argued that collars cause more harm than good, and that we should simply stop using them. In this critical review, we discuss the pros and cons of collar use in trauma patients and reflect on how we can move our clinical practice forward. Conclusively, we propose a safe, effective strategy for prehospital spinal immobilization that does not include routine use of collars.

背景与目标： : 颈圈已用于创伤患者30多年，是最先进的院前创伤护理的标志。但是，这种做法的现有证据是有限的: 随机，对照试验在很大程度上缺失，并且对死亡率，神经损伤和脊柱稳定性的影响不确定。更令人担忧的是，越来越多的证据和意见反对使用项圈。有人认为，衣领弊大于利，我们应该停止使用它们。在这篇重要的评论中，我们讨论了在创伤患者中使用项圈的利弊，并反思了如何推动我们的临床实践。最后，我们提出了一种安全，有效的院前脊柱固定策略，其中不包括常规使用项圈。

BACKGROUND & AIMS: BACKGROUND:Published reports describing management of complex facial lacerations in the emergency department are limited, and there is little guidance on the treatment of massive soft tissue avulsions of the head and face or severely contaminated head and face lacerations. Here, the authors report on the wealth of clinical experience they have gained in treating major head and facial injuries through an emergency trauma repair platform that was established in the department of orthopedic surgery at their hospital. METHODS:Six patients with massive soft tissue avulsions of the head and face caused by trauma were treated in our department between September 2017 and December 2018. Avulsion injuries occurred to the eyelids, ears, face, and part of the scalp. Defects extended from the skin to the surface of the bone. Emergency surgical repair involved reasonable debridement of the wound surface, accurate and meticulous suture, and use of local skin flaps. RESULTS:No patients experienced postoperative complications, such as necrosis, infection, or scar hyperplasia. Our postoperative satisfaction survey showed that 3 patients were very satisfied and 1 patient was relatively satisfied with their outcomes. Several patients (2/6) still had some degree of deformity in the soft tissue around the eyes, which required further surgery CONCLUSION:: Satisfactory functional and aesthetic outcomes can be achieved through reasonable debridement of the wound surface, accurate and meticulous suture, and use of local skin flaps in patients with massive soft tissue avulsions of the head and face caused by trauma.

背景与目标：

BACKGROUND & AIMS: PURPOSE:To describe ocular injuries attributable to paintball-related trauma and their management and results. DESIGN:Retrospective, interventional case series. METHODS:setting: University practice and emergency department. patient population: Thirty-six eyes of 36 patients who sustained ocular injuries secondary to paintballs between July 1, 1998 and January 1, 2005. observation procedure: Age, gender, laterality, setting, eye protection, best-corrected visual acuity (BCVA), and initial diagnosis were documented. main outcome measures: Medical and surgical intervention within the first three days postinjury and further treatment after this time period were recorded. BCVA at the initial and final clinical visit were compared. RESULTS:The mean follow-up interval was 11.7 months (one to 40). Mean age was 21 years (three to 64), 31 (86%) were male, 34 (97%) were not wearing eye-protection device when injured, and initial BCVA was worse than 20/200 in 28 eyes (78%). The most common ocular finding was hyphema in 29 eyes (81%). Initially, 20 eyes (56%) were managed medically and nine eyes (25%) required primary repair of a ruptured globe. Ultimately, 29 eyes (81%) had surgical intervention including eight eyes (22%) enucleations. Final visual acuity was 20/40 or better in 13 eyes (36%), whereas 18 eyes (50%) were worse than 20/200. Visual acuity (VA) at initial presentation correlated strongly with final VA (r = 0.64; P < .001). CONCLUSIONS:Paintball-related ocular injuries are frequently severe and visually devastating. The compulsive use of protective eyewear may have eliminated 97% of injuries in this series and continues to need emphasis to paintball users.

背景与目标：

BACKGROUND & AIMS: :A positive direct antiglobulin test has been reported in 1:1000 to 1:14,000 blood donors and 1-15 % of hospital patients. Drugs may cause a positive direct antiglobulin test result and/or immune-mediated haemolysis with an incidence of approximately 1 in a 1 million population. Our aim is to highlight the importance of following strict transfusion protocols and management insight in a direct antiglobulin test positive patient showing incompatibility with multiple units possibly due to drug induced immune haemolytic anaemia (DIIHA). We also aim to highlight importance of autologous blood transfusion in an orthopaedic procedure in which homologous transfusion may be needed. We are presenting case of a 36 year old male with alleged h/o of road traffic accident with comminuted intra-articular fracture of the distal femur. He had h/o of ankylosing spondylitis since last 20 years on medication with indomethacin and methotrexate. A review of the literature was performed which showed use of drug methotrexate as an uncommon clinical entity for DIIHA; sporadic reports exist in the medical literature to support this view. The review of the literature in combination with our own data showed methotrexate can be a cause of DIIHA. We therefore advocate proper immunohaematological work up and use of autologous blood for management of at-risk-patients of DIIHA.

背景与目标： : 据报道，1:14 000名献血者和1-15% 名医院患者的直接抗球蛋白试验呈阳性，为1:1000。在100万人群中，药物可引起阳性的直接抗球蛋白试验结果和/或免疫介导的溶血，发生率约为1。我们的目的是强调在直接抗球蛋白试验阳性患者中遵循严格的输血方案和管理见解的重要性，该患者可能由于药物诱导的免疫性溶血性贫血 (DIIHA) 而与多个单位不相容。我们还旨在强调自体输血在可能需要同源输血的骨科手术中的重要性。我们正在介绍一名36岁男性，据称是道路交通事故的h/o，股骨远端关节内粉碎性骨折。自过去20年以来，他一直使用吲哚美辛和甲氨蝶呤治疗强直性脊柱炎。对文献进行了回顾，结果表明使用药物甲氨蝶呤作为DIIHA的罕见临床实体; 医学文献中存在零星的报道来支持这一观点。结合我们自己的数据对文献的回顾表明，甲氨蝶呤可能是DIIHA的原因。因此，我们提倡进行适当的免疫血液学检查，并使用自体血来管理高危DIIHA患者。

BACKGROUND & AIMS: :A study of a 22-year-old male who was assaulted and sustained a left orbital floor blowout fracture was presented in this study. The orbital floor was repaired with a titanium-reinforced porous polyethylene implant. Two years postoperatively, the patient sustained repeated left orbital trauma. The orbital floor implant remained stable while the medial wall blew out.

背景与目标： : 这项研究对一名22岁的男性进行了研究，该男性遭到殴打并遭受了左眶底爆裂性骨折。用钛增强的多孔聚乙烯植入物修复了眼眶底。术后两年，患者反复遭受左眶外伤。眼眶底植入物保持稳定，而内侧壁炸毁。