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Fig. 3

Histologic results. A-C, HE staining disclosed myocytolysis and in the myocardium of the VF + ES and asphyxia groups. In the VF + ES group, waving was also observed. The distribution of contraction bands in the asphyxia group is more diffuse than that in the VF + ES group. D-F, Gomori staining of the VF + ES and asphyxia groups showed a ragged thick and irregular red subsarcolemmal layer and intermyofibrillar red deposits suggesting the aggregation of abnormal mitochondria (arrow). Rather than the mitochondrial aggregation distributed in some area of myocardium in the VF + ES group, the mitochondrial aggregation in the asphyxia group showed diffuse distribution in the myocardium. G-I, Electron microscopic analysis (×20 000) of the LV in the VF + ES and asphyxia groups showed mitochondrial damage characterized by mitochondrial swelling and edema, outer-membrane rupture, and loss of inner-membrane cristae with amorphous densities (hollow arrow). The mitochondrial damage in the VF + ES group was limited in some area of myocardium; in contrast, the asphyxia group showed generalized mitochondrial damage in the myocardium. Some unclear mitochondrial border in the sham group comes from the mosaic of the cutting edge. ASP indicates asphyxia; TEM, transmission electron microscopy.

Fig. 5

Mitochondrial respiration. A, The state 3 respiration was significantly lower in the VF + ES and asphyxia groups than in the sham group. The state 3 respiration of the asphyxia group decreased more significantly than that of the VF + ES group. B, No significant difference in the state 4 rate between each group was noted. C, The mitochondria from the VF + ES group showed a trend of decreased RCR when compared with the sham group. The RCR of the asphyxia group was significantly lower than the VF + ES and sham groups. D, When compared with the sham group, the ADP/O ratios of the VF + ES and asphyxia groups were significantly decreased. Moreover, the ADP/O ratio was lower in the asphyxia group than in the VF + ES group. ASP indicates asphyxia. ⁎P < .05.

Fig. 4

The results of mPTP opening and complex activity studies. A, After adding CaCl2, both the VF + ES and the asphyxia groups had significantly accelerated rates of Ca2+-induced mitochondrial swelling, a measure of mPTP opening, compared with sham-operated rats. The mitochondrial swelling of the asphyxia group was faster than that of the VF + ES group. B-D, The VF + ES group decreased the activities of NCCR and CCO but not SCCR when compared with sham. However, in the asphyxia group, only the CCO activity significantly decreased when compared with the VF + ES and sham groups. There was no significant difference in NCCR between the asphyxia and the sham groups. ASP indicates asphyxia. ⁎P < .05.

Fig. 2

A, Probability of survival, mean fluid volume, and duration of fluid administration during hospitalization, according to fluid management. B, Volume of l- and d-lactate administered during hospitalization and before starting mechanical ventilation, according to fluid management. The evaluation of an extensive range of fluid types and volumes in this study is justified because they may affect mortality. All data are presented as means with SDs. Group 1: patients administered fluids other than Ringer's lactate; group 2: patients administered Ringer's dl-lactate; group 3: patients administered Ringer's lactate without d-lactate.

Fig. 2

Emergency management and transfer triage of 38 patients based on the basic status (vital sign) and POC ultrasound examination. In the first step, vital sign were quickly evaluated. In the second step, POC ultrasound was used for further screening of patients (vital sign unstable was screened first). In the third step, immediate management was done according to the results provided by POC ultrasound. Then in the fourth step, transfer triage was made according to POC screening results—vital sign unstable first (after targeted initial management) > stable patient with positive POC ultrasound result > stable patient with negative echo result.

Fig. 3

The scatter graphs of the NF-κB translocations (A) and Nrf2 expressions (B) with the in vitro TNF-α levels in PBMCs after endotoxin stimulation at 24 and 72 hours after injury. Nuclear factor κB translocation shows significant correlation with the TNF-α levels (Spearman ρcorrelation analysis: R = 0.424, P = .016 at 24 hours; R = 0.379, P = .032 at 72 hours). The trend of negative correlation of Nrf2 expression and TNF-α levels at 24 hours was without significance (R = -0.323, P = .072 at 24 hours; R = −0.266, P = .141 at 72 hours).

Fig. 1

Patient flow. Because the number of days that blood products are administered partly determines the use of mechanical ventilation later than 48 hours after admission, only mean volume per day was considered. Of 24 616 patients across 188 hospitals eligible for this analysis, 9 753 patients received fluids other than Ringer's lactate (group 1), 2 827 received fluids including Ringer's dl-lactate (group 2), and 12 036 received Ringer's lactate fluids other than d-lactate (group 3).

Fig. 4

Receiving operating characteristics curves of the GCS score (A), T-RTS (B), MGAP (C), and TRISS (D) using the full GCS or its motor component only (GCSm, T-RTSm, MGAPm, TRISSm) (n = 1690). P values refer to the comparison of the area under the ROC curve between the 2 scores (eg, GCS vs GCSm ). All areas under the ROC curves were significantly different from 0.50 (ie, no discrimination). The dotted line corresponds to the nondiscrimination curve.

Fig. 3

Comparison of the sites of massive bleeding in the younger and older groups.

Group A was defined as diagnosable cases at the primary survey, whereas group B was defined as non-diagnosable cases. Older patients had a significantly higher risk of non-diagnosable bleeding, compared to the younger patients (OR, 3.92; 95% CI, 1.37-11.27; P = .017).

Fig. 1

Nuclear factor κB translocation and p-IκB-α expression at 24 and 72 hours after injury (ratio to control). A, Patients with critical injury had significantly decreased NF-κB signals compared with the counter group (*P < .01; ISS ≥25 vs ISS <25). B, There was no significant discrepancy between patients with organ failure (org. failure) or without org. failure (no failure) at 24 and 72 hours after injury.

Fig. 2

Body region injured by team type, maneuver attempted, and mechanism of injury.

Fig. 1

Body region injured.

Fig. 1

A and B, A case of the VP at a rib in the chest.

This case shows the VP at a rib (A, white arrow). This case had rib fractures.

The black arrow indicates the VP located posterior to the sternum (B). However, this lesion was not considered to be the VP because it was located in the thoracic cavity in this study.

Fig. 1

Number of reported injuries by severity.

Fig. 2

Number of reported illnesses by severity.

Fig. 3

Route of the Iditarod Trail Sled Dog Race.

Fig. 1

Annual number and rate of swimming injuries among individuals 7 years or older treated in US hospital EDs according to year of injury, 1990-2008.

Fig. 1

Patients’ disposition.

Patients with massive bleeding: cases requiring ≥10 units of red cell concentrate within 24 hours of admission, or cases of early death due to massive bleeding.

Fig. 2

Site of the massive bleeding in the younger and older groups.

Fig. 2

Swimming injuries among individuals treated in US hospital EDs according to body region injured for all body regions, head and neck, and lower extremity.