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Endotheliopathy trauma

Charles E Wade, Nena Matijevic, Yao-Wei W Wang, Erika Gonzalez Rodriguez, Ernesto Lopez, Sisse R Ostrowski, Jessica C Cardenas, Lisa A Baer, Tzu-An Chen, Jeffrey S Tomasek, Hanne H Henriksen, Jakob Stensballe, Bryan A Cotton, John B Holcomb, Pär I Johansson
INTRODUCTION: Severe trauma is accompanied by endothelial glycocalyx disruption, which drives coagulopathy, increasing transfusion requirements and death. This syndrome has been termed traumatic endotheliopathy (EOT). Some have suggested EOT results from endothelial cellular damage and apoptosis. Endothelial microvesicles (EMVs) represent cellular damage. We hypothesized that EOT is associated with endothelial damage and apoptosis resulting in an increase in circulating EMVs. METHODS: Prospective, observational study enrolling severely injured patients...
April 4, 2018: Shock
Jae C Chang
: 'Disseminated intravascular coagulation (DIC)' occurs commonly in critical illnesses such as sepsis, trauma, cancer, and complications of surgery and pregnancy. Mortality is very high. The pathogenesis has been ascribed to tissue factor-initiated coagulation disorder, resulting in disseminated microblood clots that are made of platelets, plasma factors, fibrins, and blood cells. True DIC depletes coagulation factors and consumes platelets, and activates fibrinolysis. 'DIC' is assumed to orchestrate thrombocytopenia, microangiopathic hemolytic anemia and hypoxic multiorgan dysfunction syndrome, and causes hemorrhagic disorder due to depleted coagulation factors...
April 4, 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Venencia Albert, Arulselvi Subramanian, Deepak Agrawal, Hara Prasad Pati, Siddhartha Datta Gupta, Asok Kumar Mukhopadhyay
STUDY DESIGN: Prospective observational cohort. OBJECTIVE: To investigate the difference in plasma levels of syndecan-1 (due to glycocalyx degradation) and soluble thrombomodulin (due to endothelial damage) in isolated severe traumatic brain injury (TBI) patients with/without early coagulopathy. A secondary objective was to compare the effects of the degree of TBI endotheliopathy on hospital mortality among patients with TBI-associated coagulopathy (TBI-AC). METHODS: Data was prospectively collected on isolated severe TBI (sTBI) patients with Glasgow Coma Scale (GCS) ≤8 less than 12 h after injury admitted to a level I trauma centre...
January 16, 2018: Medical Sciences: Open Access Journal
Lawrence N Diebel, Jonathan V Martin, David M Liberati
BACKGROUND: Early resuscitation after trauma-hemorrhagic shock with plasma rather than crystalloid may ameliorate systemic endothelial cell (EC) injury and dysfunction (endotheliopathy of trauma). We postulated that endothelial-lined microfluidic networks would be a useful platform to study the EC activation/injury under flow conditions to mimic trauma-hemorrhagic shock. We then used the microfluidic system to further characterize the protective effects and optimal timing of plasma infusion on the development of "endotheliopathy of trauma" in our model...
April 2018: Journal of Trauma and Acute Care Surgery
David N Naumann, Jon Hazeldine, Robert J Dinsdale, Jon R Bishop, Mark J Midwinter, Paul Harrison, Sam D Hutchings, Janet M Lord
BACKGROUND: Cell free deoxyribonucleic acid (cfDNA) has been proposed as a biomarker of secondary complications following trauma. Raised thrombomodulin and syndecan-1 levels have been used to indicate endotheliopathy, and are associated with inflammation, coagulopathy, and mortality. The current study aimed to analyse the association between cfDNA and biomarkers of endotheliopathy in a cohort of trauma patients, and whether raised levels of cfDNA were associated with poorer clinical outcomes...
2017: PloS One
Erika Gonzalez Rodriguez, Jessica C Cardenas, Ernesto Lopez, Bryan A Cotton, Jeffrey S Tomasek, Sisse R Ostrowski, Lisa A Baer, Jakob Stensballe, John B Holcomb, Pär I Johansson, Charles E Wade
OBJECTIVE: Traumatic endotheliopathy (EoT) is associated with glycocalyx breakdown and capillary leak resulting in the extravasation of proteins. We hypothesized that lower serum albumin levels are associated with EoT, poor outcomes, and can be used for early EoT screening in trauma patients. METHODS: We enrolled severely injured trauma patients with serum albumin levels available on admission. Syndecan-1 and soluble thrombomodulin were quantified from plasma by ELISA...
October 18, 2017: Shock
David N Naumann, Jon Hazeldine, David J Davies, Jon Bishop, Mark J Midwinter, Antonio Belli, Paul Harrison, Janet M Lord
BACKGROUND: Trauma patients are vulnerable to coagulopathy and inflammatory dysfunction associated with endotheliopathy of trauma (EoT). In vitro evidence has suggested that tranexamic acid (TXA) may ameliorate endotheliopathy. We aimed to investigate how soon after injury EoT occurs, its association with multiple organ dysfunction syndrome (MODS), and whether TXA ameliorates it. METHODS: A prospective observational study included 91 trauma patients enrolled within 60 min of injury and 19 healthy controls...
April 2018: Shock
David N Naumann, Jon Hazeldine, Mark J Midwinter, Sam D Hutchings, Paul Harrison
BACKGROUND: Endothelial cell damage and glycocalyx shedding after trauma can increase the risk of inflammation, coagulopathy, vascular permeability, and death. Bedside sublingual video-microscopy may detect worse flow and perfusion associated with this endotheliopathy. We compared markers of endotheliopathy with physical flow dynamics after traumatic hemorrhagic shock. METHODS: Sublingual incident dark field video-microscopy was performed at three time points after injury (<10 hours, 10-30 hours, and 30-50 hours)...
January 2018: Journal of Trauma and Acute Care Surgery
Erika Gonzalez Rodriguez, Sisse R Ostrowski, Jessica C Cardenas, Lisa A Baer, Jeffrey S Tomasek, Hanne H Henriksen, Jakob Stensballe, Bryan A Cotton, John B Holcomb, Pär I Johansson, Charles E Wade
BACKGROUND: Endothelial glycocalyx breakdown elicits syndecan-1 shedding and endotheliopathy of trauma (EoT). We hypothesized that a cutoff syndecan-1 level can identify patients with endothelial dysfunction who would have poorer outcomes. STUDY DESIGN: We conducted a prospective observational study. Trauma patients with the highest level of activation admitted from July 2011 through September 2013 were eligible. We recorded demographics, injury type/severity (Injury Severity Score), physiology and outcomes data, and quantified syndecan-1 and soluble thrombomodulin from plasma with ELISAs...
September 2017: Journal of the American College of Surgeons
Lawrence N Diebel, Jonathan V Martin, David M Liberati
BACKGROUND: Systemic vascular endothelial injury is a consequence of trauma (T)/hemorrhagic shock (HS) which results in disturbances of coagulation, inflammation, and endothelial barrier integrity. The effect of T/HS on the endothelium (endotheliopathy of trauma [EoT]) is of intense research interest and may lead to EoT-directed therapies. Administration of tranexamic acid (TXA) in trauma patients is associated with a survival benefit and fewer complications if given early after injury...
June 2017: Journal of Trauma and Acute Care Surgery
Pär Ingemar Johansson, Jakob Stensballe, Sisse Rye Ostrowski
One quarter of patients suffering from acute critical illness such as severe trauma, sepsis, myocardial infarction (MI) or post cardiac arrest syndrome (PCAS) develop severe hemostatic aberrations and coagulopathy, which are associated with excess mortality. Despite the different types of injurious "hit", acutely critically ill patients share several phenotypic features that may be driven by the shock. This response, mounted by the body to various life-threatening conditions, is relatively homogenous and most likely evolutionarily adapted...
February 9, 2017: Critical Care: the Official Journal of the Critical Care Forum
Sisse R Ostrowski, Hanne H Henriksen, Jakob Stensballe, Mikkel Gybel-Brask, Jessica C Cardenas, Lisa A Baer, Bryan A Cotton, John B Holcomb, Charles E Wade, Pär I Johansson
BACKGROUND: One third of severely injured patients present with a laboratory-based diagnosis of coagulopathy. This study investigated clinical and biomarker profile of patients with rapid thrombelastography (rTEG) coagulopathy, hypothesizing that sympathoadrenal activation and endothelial damage were drivers of this condition. METHODS: Prospective observational study of 404 trauma patients admitted to a Level 1 US Trauma Center. Patients with admission rTEG and plasma measurements of catecholamines (adrenaline, noradrenaline) and biomarkers reflecting endothelial activation/damage (syndecan-1, thrombomodulin, sE-selectin, sVE-cadherin, nucleosomes) were included...
February 2017: Journal of Trauma and Acute Care Surgery
Alex P Di Battista, Sandro B Rizoli, Brandon Lejnieks, Arimie Min, Maria Y Shiu, Henry T Peng, Andrew J Baker, Michael G Hutchison, Nathan Churchill, Kenji Inaba, Bartolomeu B Nascimento, Airton Leonardo de Oliveira Manoel, Andrew Beckett, Shawn G Rhind
BACKGROUND: Acute coagulopathy after traumatic brain injury (TBI) involves a complex multifactorial hemostatic response that is poorly characterized. OBJECTIVES: To examine early posttraumatic alterations in coagulofibrinolytic, endothelial, and inflammatory blood biomarkers in relation to sympathetic nervous system (SNS) activation and 6-month patient outcomes, using multivariate partial least-squares (PLS) analysis. PATIENTS AND METHODS: A multicenter observational study of 159 adult isolated TBI patients admitted to the emergency department at an urban level I trauma center, was performed...
September 2016: Shock
Pär I Johansson, Hanne H Henriksen, Jakob Stensballe, Mikkel Gybel-Brask, Jessica C Cardenas, Lisa A Baer, Bryan A Cotton, John B Holcomb, Charles E Wade, Sisse R Ostrowski
OBJECTIVE: Investigate and confirm the association between sympathoadrenal activation, endotheliopathy and poor outcome in trauma patients. BACKGROUND: The association between sympathoadrenal activation, endotheliopathy, and poor outcome in trauma has only been demonstrated in smaller patient cohorts and animal models but needs confirmation in a large independent patient cohort. METHODS: Prospective observational study of 424 trauma patients admitted to a level 1 Trauma Center...
March 2017: Annals of Surgery
Shibani Pati, Daniel R Potter, Gyulnar Baimukanova, David H Farrel, John B Holcomb, Martin A Schreiber
BACKGROUND: Transfusion of balanced ratios of plasma to platelets and red blood cells has been shown to reduce early death from exsanguination in trauma patients. Aside from hemostasis, recent work has shown that plasma reduces vascular endothelial permeability, inflammation, and organ edema after hemorrhagic shock (HS), all components of the endotheliopathy of trauma. We hypothesized that Kcentra could have protective effects on the endotheliopathy of trauma comparable with fresh frozen plasma (FFP)...
April 2016: Journal of Trauma and Acute Care Surgery
John B Holcomb, Shibani Pati
Over the past century, blood banking and transfusion practices have moved from whole blood therapy to components. In trauma patients, the shift to component therapy was achieved without clinically validating which patients needed which blood products. Over the past 4 decades, this lack of clinical validation has led to uncertainty on how to optimally use blood products and has likely resulted in both overuse and underuse in injured patients. However, recent data from both US military operations and civilian trauma centers have shown a survival advantage with a balanced transfusion ratio of RBCs, plasma, and platelets...
2013: Hematology—the Education Program of the American Society of Hematology
L Arellanes García, G Ortiz-Ponce, C Recillas-Gispert
A peripheral corneal endotheliopathy (PCE), named autoimmune endotheliopathy was described in association with corneal graft rejection and as an isolated corneal alteration unrelated to surgery, trauma, or infection. It has also been found in patients with pars planitis (PP), but the significance of this association is unknown. The authors retrospectively reviewed the clinical charts of 53 PP patients (106 eyes) examined at the Uveitis Clinic from 1988 to 1993. Special attention was paid to the description of corneal clinical findings...
1996: Ocular Immunology and Inflammation
Xiaodong Zheng, Yasushi Inoue, Atsushi Shiraishi, Yoko Hara, Tomoko Goto, Yuichi Ohashi
BACKGROUND: Bullous keratopathy (BK), a severe sight-threatening disorder can have a variety of etiologies such as prophylactic laser iridotomy, intraocular surgery, trauma, and other ocular disorders. However, there are cases of unknown origins, among which a unique clinical entity namely pseudoexfoliation syndrome (PEX) is having increased importance. CASE PRESENTATION: In this case note, we report the clinical features and in vivo confocal microscopic and pathological findings of two BK cases of unknown cause...
2012: BMC Ophthalmology
Stephen J Dorrepaal, Kathy Y Cao, Allan R Slomovic
BACKGROUND: The leading indications for penetrating keratoplasty (PKP) have changed over recent years. This study examined the leading indications for PKP and their trends, comparing these with recently published data from other studies, including a report from our centre examining indications from 1986 through 1995. METHODS: A retrospective chart review was conducted of all patients who underwent PKP in a single practice at the University Health Network, Toronto Western Hospital, between July 1, 1996, and June 30, 2004...
April 2007: Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie
A A Khodadoust, A Attarzadeh
Two men (58 and 19 years of age) had an unusual recurrent, bilaterally symmetric disease process involving the cornea. It is characterized by stromal edema progressing centrally from the periphery in otherwise normal eyes. The corneal edema in each instance was closely associated with slowly moving linear keratic precipitates accompanied by the destruction of the endothelium, with minimal anterior chamber reaction. There was no history of herpetic keratitis or trauma, and serologic tests for syphilis were negative in both cases...
June 1982: American Journal of Ophthalmology
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