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Trauma shock

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https://www.readbyqxmd.com/read/28439099/optogenetic-silencing-of-a-corticotropin-releasing-factor-pathway-from-the-central-amygdala-to-the-bed-nucleus-of-the-stria-terminalis-disrupts-sustained-fear
#1
A Asok, A Draper, A F Hoffman, J Schulkin, C R Lupica, J B Rosen
The lateral central nucleus of the amygdala (CeAL) and the dorsolateral bed nucleus of the stria terminalis (BNSTDL) coordinate the expression of shorter- and longer-lasting fears, respectively. Less is known about how these structures communicate with each other during fear acquisition. One pathway, from the CeAL to the BNSTDL, is thought to communicate via corticotropin-releasing factor (CRF), but studies have yet to examine its function in fear learning and memory. Thus, we developed an adeno-associated viral-based strategy to selectively target CRF neurons with the optogenetic silencer archaerhodopsin tp009 (CRF-ArchT) to examine the role of CeAL CRF neurons and projections to the BNSTDL during the acquisition of contextual fear...
April 25, 2017: Molecular Psychiatry
https://www.readbyqxmd.com/read/28433042/-alarmins-and-surgical-injury
#2
J Máca, M Peteja
Surgical intervention is an inseparable part of the management of serious surgical disease. However, surgery also presents a potential risk related to the so-called surgical injury causing immune response. When dysregulated the immune activation is able to cause local complications (i.e. wound dehiscence, impaired healing). Systemic decompartmentization of the immunologic disturbance can negatively influence long-term outcomes (i.e. hospital length of stay, mortality). Due to aseptic conditions in the operating room, such an immune activation is almost always of sterile nature...
2017: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
https://www.readbyqxmd.com/read/28431991/molecular-mechanisms-of-trauma-induced-acute-kidney-injury-inflammatory-and-metabolic-insights-from-animal-models
#3
David M Burmeister, Belinda I Gómez, Michael A Dubick
Trauma-induced acute kidney injury (AKI), such as after hemorrhagic shock (HS) or burn, remains a significant problem in the intensive care unit and is associated with increased mortality. The pathophysiology that drives AKI post-trauma is multi factorial, and includes both inflammatory and metabolic alterations. Identifying the systemic profile that contributes to AKI is crucial not only for early diagnosis, but also for identifying treatments that improve kidney function and maintaining long-term patient health...
April 18, 2017: Biochimica et Biophysica Acta
https://www.readbyqxmd.com/read/28430760/resuscitative-endovascular-balloon-occlusion-of-the-aorta-or-resuscitative-thoracotomy-with-aortic-clamping-for-noncompressible-torso-hemorrhage-a-retrospective-nationwide-study
#4
Shotaro Aso, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging treatment for noncompressible torso hemorrhage. It remains unclear if REBOA is superior to resuscitative thoracotomy with aortic cross-clamping (RT) in terms of improving outcomes. This study compared in-hospital outcomes between REBOA and RT in trauma patients with uncontrolled hemorrhagic shock, using data from a national inpatient database in Japan. METHODS: Using the Diagnosis Procedure Combination database, we identified patients who received REBOA or RT within 1 day after admission from July 1, 2010, to March 31, 2014...
May 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28429475/common-carotid-artery-sonography-versus-transthoracic-echocardiography-for-cardiac-output-measurements-in-intensive-care-unit-patients
#5
Qian-Yi Peng, Li-Na Zhang, Mei-Lin Ai, Li Li, Cheng-Huan Hu, Yan-Xin Zhang, Wei Liu, Qing Feng, Yu Zou, Yu-Hang Ai
OBJECTIVES: This study was designed to test the effectiveness of common carotid artery sonography in comparison with transthoracic echocardiography (TTE) for cardiac output measurements to provide an easier alternative for cardiac output monitoring in the intensive care unit. METHODS: This study included 148 patients who had common carotid artery Doppler examinations and TTE performed within 8 hours of each other, and the cardiac output measurement results were compared with each other...
April 21, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28424126/the-novel-use-of-resuscitative-endovascular-balloon-occlusion-of-the-aorta-to-explore-a-retroperitoneal-hematoma-in-a-hemodynamically-unstable-patient
#6
Martin D Rosenthal, Ahsan Raza, Stephanie Markle, Chasen A Croft, Alicia M Mohr, R Stephen Smith
Balloon occlusion of the aorta was first described by C.W. Hughes in 1954, when it was used as a tamponade device for three wounded soldiers during the Korean War suffering from intra-abdominal hemorrhage. Currently, the device is indicated in trauma patients as a surrogate for resuscitative thoracotomy. Brenner et al. reported a case series describing the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in advanced hemorrhagic shock. Their conclusion was that "it is a feasible method for proximal aortic control...
April 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28422768/mechanisms-involved-in-secondary-cardiac-dysfunction-in-animal-models-of-trauma-and-haemorrhagic-shock
#7
Nick M Wilson, Johanna Wall, Veena Naganathar, Karim Brohi, Henry D De'Ath
Clinical evidence reveals the existence of a trauma induced secondary cardiac injury (TISCI) which is associated with poor patient outcomes. The mechanisms leading to TISCI in injured patients are uncertain. Conversely, animal models of trauma haemorrhage have repeatedly demonstrated significant cardiac dysfunction following injury, and highlighted mechanisms through which this might occur. The aim of this review was to provide an overview of the animal studies describing TISCI and its pathophysiology.Basic science models of trauma show evidence of innate immune system activation via Toll-Iike receptors (TLRs), the exact protagonists of which remain unclear...
April 18, 2017: Shock
https://www.readbyqxmd.com/read/28421780/intestinal-dysfunction-in-the-critical-trauma-patients-an-early-and-frequent-event
#8
Beatriz Pinto Costa, Paulo Martins, Carla Verissimo, Marta Simões, Marisa Tomé, Manuela Grazina, Jorge Pimentel, Francisco Castro-Sousa
BACKGROUND: Small-bowel dysfunction exerts a relevant prognostic impact in the critically ill patients. Citrullinemia has been used in the evaluation of the intestinal function and it is considered an objective parameter of the functional enterocyte mass. Present study proposes to determine the intestinal dysfunction prevalence and the citrullinemia kinetic profile in severe trauma patients and to investigate its correlation with severity indicators and clinical outcome. METHODS: A prospective study including 23 critical trauma patients was performed...
March 30, 2017: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
https://www.readbyqxmd.com/read/28413267/vasopressors-do-they-have-any-role-in-hemorrhagic-shock
#9
REVIEW
Babita Gupta, Neha Garg, Rashmi Ramachandran
The priority in the management of patients with traumatic hemorrhagic shock is to control the bleeding with simultaneous volume resuscitation to maintain adequate tissue perfusion. Fluid replacement remains the mainstay of initial resuscitation in hemorrhagic shock. Traditionally, vasopressors are contraindicated in the early management of hemorrhagic shock due to their deleterious consequences, although vasopressors may have a role in resuscitation when vasoplegic shock ensues and blood pressure cannot be maintained by fluids alone...
January 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/28407781/early-identification-of-patients-requiring-massive-transfusion-embolization-or-hemostatic-surgery-for-traumatic-hemorrhage-a-systematic-review-protocol
#10
Alexandre Tran, Maher Matar, Ewout W Steyerberg, Jacinthe Lampron, Monica Taljaard, Christian Vaillancourt
BACKGROUND: Hemorrhage is a major cause of early mortality following a traumatic injury. The progression and consequences of significant blood loss occur quickly as death from hemorrhagic shock or exsanguination often occurs within the first few hours. The mainstay of treatment therefore involves early identification of patients at risk for hemorrhagic shock in order to provide blood products and control of the bleeding source if necessary. The intended scope of this review is to identify and assess combinations of predictors informing therapeutic decision-making for clinicians during the initial trauma assessment...
April 13, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28406853/the-role-of-computed-tomography-in-the-classification-of-pediatric-pelvic-fractures-revisited
#11
Bent Ma, Hennrikus Wl, Latorre Je, Armstrong Dg, Shaw B, Jones Kc, Segal Ls
OBJECTIVES: To determine the need of CT scans in the assessment of pediatric pelvic fractures DESIGN:: Retrospective Chart Review SETTING:: Level-1 Pediatric Trauma CenterPatients/Participants: 30 pediatric trauma patients with pelvic fractures who have obtained both a radiograph and CT Scan MAIN OUTCOME MEASUREMENTS:: Fleiss Kappa coefficient to compare inter-reliability. RESULTS: The average age of the patients was 7 years (range 1-13 years). 17 were male and 13 were female...
April 10, 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28400940/early-diagnosis-of-penetrating-cardiac-and-pleural-injury-by-extended-focused-assessment-with-sonography-for-trauma
#12
K P Singaravelu, Rama Prakasha Saya, Vinay R Pandit
In India, stab injury is not uncommon, but identifying potential life threatening conditions in the emergency room (ER) and initiating prompt treatment are challenging. This is a case report of a young patient who presented to the ER with assault injury to the chest and shock; timely extended focused assessment with sonography for trauma helped to fast-track the patient to the operating room. A brief review of diagnosis and management of penetrating cardiac injury is presented herewith.
October 2016: Heart Views: the Official Journal of the Gulf Heart Association
https://www.readbyqxmd.com/read/28400499/the-coherence-of-macrocirculation-microcirculation-and-tissue-metabolic-response-during-nontraumatic-hemorrhagic-shock-in-swine
#13
Halvor Langeland, Oddveig Lyng, Petter Aadahl, Nils-Kristian Skjærvold
Hemorrhagic shock is clinically observed as changes in macrocirculatory indices, while its main pathological constituent is cellular asphyxia due to microcirculatory alterations. The coherence between macro- and microcirculatory changes in different shock states has been questioned. This also applies to the hemorrhagic shock. Most studies, as well as clinical situations, of hemorrhagic shock include a "second hit" by tissue trauma. It is therefore unclear to what extent the hemorrhage itself contributes to this lack of circulatory coherence...
April 2017: Physiological Reports
https://www.readbyqxmd.com/read/28398934/pediatric-lawnmower-injuries
#14
Tina S Lee, Jan D Luhmann, Scott J Luhmann, Kimberly S Quayle
OBJECTIVE: The aim of this study was to evaluate demographics, characteristics, and mechanisms of injuries caused by lawnmowers in children. METHODS: Chart review from 1990 to 2010 at a level I pediatric trauma center identified patients younger than 18 years with lawnmower injuries. Demographics and characteristics of the injuries were analyzed by descriptive statistical analysis. RESULTS: The study identified 88 subjects, with 80% males and 42% of the subjects younger than 5 years...
April 11, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28396721/resection-of-complex-pancreatic-injuries-benchmarking-postoperative-complications-using-the-accordion-classification
#15
Jake E Krige, Eduard Jonas, Sandie R Thomson, Urda K Kotze, Mashiko Setshedi, Pradeep H Navsaria, Andrew J Nicol
AIM: To benchmark severity of complications using the Accordion Severity Grading System (ASGS) in patients undergoing operation for severe pancreatic injuries. METHODS: A prospective institutional database of 461 patients with pancreatic injuries treated from 1990 to 2015 was reviewed. One hundred and thirty patients with AAST grade 3, 4 or 5 pancreatic injuries underwent resection (pancreatoduodenectomy, n = 20, distal pancreatectomy, n = 110), including 30 who had an initial damage control laparotomy (DCL) and later definitive surgery...
March 27, 2017: World Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28396047/prediction-of-massive-bleeding-shock-index-and-modified-shock-index
#16
L J Terceros-Almanza, C García-Fuentes, S Bermejo-Aznárez, I J Prieto-Del Portillo, C Mudarra-Reche, I Sáez-de la Fuente, M Chico-Fernández
OBJECTIVE: To determine the predictive value of the Shock Index and Modified Shock Index in patients with massive bleeding due to severe trauma. DESIGN: Retrospective cohort. SETTING: Severe trauma patient's initial attention at the intensive care unit of a tertiary hospital. SUBJECTS: Patients older than 14 years that were admitted to the hospital with severe trauma (Injury Severity Score >15) form January 2014 to December 2015...
April 8, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28394020/-we-will-never-be-normal-the-experience-of-discovering-a-partner-has-autism-spectrum-disorder
#17
Laura F Lewis
Online forums and lay literature suggest that partners of individuals with Autism Spectrum Disorder (ASD) experience depression, distress, and trauma in their everyday lives, exacerbated during the time surrounding diagnosis. In this content analysis, 29 participants were provided with an online open-ended statement asking them to describe in writing their experiences of discovering that their partners had ASD during their relationships. Six themes emerged, including: facing unique challenges within relationships; insisting partners seek diagnosis; initial shock and relief; losing hope for normalcy; making accommodations within relationships; and wishing for professional support...
April 10, 2017: Journal of Marital and Family Therapy
https://www.readbyqxmd.com/read/28392701/evaluation-of-the-clinical-effect-of-small-volume-resuscitation-on-uncontrolled-hemorrhagic-shock-in-emergency
#18
Gang Zhao, Wei Wu, Qi-Ming Feng, Jian Sun
OBJECTIVE: The objective of the present study was to explore the resuscitative effect of small-volume resuscitation on uncontrolled hemorrhagic shock in emergency. METHODS: In this study, the resuscitative effects in 200 trauma patients with uncontrolled hemorrhagic shock in emergency were studied. Half of these patients were infused with hypertonic/hyperoncotic fluid (small-volume resuscitation group, n=100), whereas the rest were infused with Hespan and lactated Ringer's solution (conventional fluid resuscitation group, n=100)...
2017: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/28389734/-intensive-care-treatment-of-traumatic-brain-injury-in-multiple-trauma-patients-decision-making-for-complex-pathophysiology
#19
H Trimmel, G Herzer, H Schöchl, W G Voelckel
Traumatic brain injury (TBI) and hemorrhagic shock due to uncontrolled bleeding are the major causes of death after severe trauma. Mortality rates are threefold higher in patients suffering from multiple injuries and additionally TBI. Factors known to impair outcome after TBI, namely hypotension, hypoxia, hypercapnia, acidosis, coagulopathy and hypothermia are aggravated by the extent and severity of extracerebral injuries. The mainstays of TBI intensive care may be, at least temporarily, contradictory to the trauma care concept for multiple trauma patients...
April 7, 2017: Der Unfallchirurg
https://www.readbyqxmd.com/read/28386315/protective-benefits-of-amp-activated-protein-kinase-in-hepatic-ischemia-reperfusion-injury
#20
REVIEW
Min Zhang, Dan Yang, Xianqiong Gong, Pu Ge, Jie Dai, Ling Lin, Li Zhang
Hepatic ischemia-reperfusion injury (HIRI) is a major cause of hepatic failure and death after liver trauma, haemorrhagic shock, resection surgery and liver transplantation. AMP-activated protein kinase (AMPK) is an energy sensitive kinase that plays crucial roles in the regulation of metabolic homeostasis. In HIRI, ischemia induces the decline of ATP and the increased ratio of AMP/ATP, which promotes the phosphorylation and activation of AMPK. Three AMPK kinases, liver kinase B1 (LKB1), Ca(2+)/calmodulin-depedent protein kinase kinase β (CaMKKβ) and TGF-β-activated kinase-1 (TAK1), are main upstream kinases for the phosphorylation of AMPK...
2017: American Journal of Translational Research
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