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https://www.readbyqxmd.com/read/29847540/patients-at-high-risk-of-intervention-for-pediatric-traumatic-liver-injury
#1
Katie A Donnelly, Kristen Breslin, Karen J OʼConnell
OBJECTIVES: Nonoperative management of hemodynamically stable liver lacerations in pediatric trauma patients is a safe and effective management strategy for pediatric patients; approximately 90% will be successfully managed nonoperatively. No study has specifically identified risk criteria for the need for intervention versus observation alone. Our objective for this study was to determine risk factors from the physical examination, computed tomography scan, and laboratory results associated with intervention for liver laceration...
May 25, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29719849/avulsion-of-ampulla-of-vater-secondary-to-a-blunt-abdominal-injury-treated-with-pancreatoduodenectomy-a-case-report-and-literature-review
#2
Mustafa Ozsoy, Ogun Ersen, Zehra Ozsoy, Sezgin Yilmaz, Yüksel Arıkan
The incidence of complex hepatobiliary injury secondary to blunt abdominal injuries varies between 3.4 and 5%. A 25-year old male patient underwent an urgent operation due to a motorcycle accident. During intraabdominal exploration, Grade 4 laceration was detected at the liver and bleeding was controlled through primary repair. In the postoperative seventh day, he was referred due to 1500 cc bile leakage from the drainage tube. During the operation, an extensive Kocher maneuver was done and the second part of duodenum was observed to be exposed to total avulsion from the head of the pancreas...
April 2018: Bulletin of Emergency and Trauma
https://www.readbyqxmd.com/read/29621998/a-factor-xia-activatable-hirudin-albumin-fusion-protein-reduces-thrombosis-in-mice-without-promoting-blood-loss
#3
William P Sheffield, Louise J Eltringham-Smith, Varsha Bhakta
BACKGROUND: Hirudin is a potent thrombin inhibitor but its antithrombotic properties are offset by bleeding side-effects. Because hirudin's N-terminus must engage thrombin's active site for effective inhibition, fusing a cleavable peptide at this site may improve hirudin's risk/benefit ratio as a therapeutic agent. Previously we engineered a plasmin cleavage site (C) between human serum albumin (HSA) and hirudin variant 3 (HV3) in fusion protein HSACHV3. Because coagulation factor XI (FXI) is more involved in thrombosis than hemostasis, we hypothesized that making HV3 activity FXIa-dependent would also improve HV3's potential therapeutic profile...
April 5, 2018: BMC Biotechnology
https://www.readbyqxmd.com/read/29593715/comparative-analysis-of-the-regulatory-t-cells-dynamics-in-peripheral-blood-in-human-and-porcine-polytrauma
#4
Rafael Serve, Ramona Sturm, Lukas Schimunek, Philipp Störmann, David Heftrig, Michel P J Teuben, Elsie Oppermann, Klemens Horst, Roman Pfeifer, Tim P Simon, Yannik Kalbas, Hans-Christoph Pape, Frank Hildebrand, Ingo Marzi, Borna Relja
Background: Severely injured patients experience substantial immunological stress in the aftermath of traumatic insult, which often results in systemic immune dysregulation. Regulatory T cells (Treg) play a key role in the suppression of the immune response and in the maintenance of immunological homeostasis. Little is known about their presence and dynamics in blood after trauma, and nothing is known about Treg in the porcine polytrauma model. Here, we assessed different subsets of Treg in trauma patients (TP) and compared those to either healthy volunteers (HV) or data from porcine polytrauma...
2018: Frontiers in Immunology
https://www.readbyqxmd.com/read/29538234/intravenous-administration-of-synthetic-platelets-synthoplatetm-in-a-mouse-liver-injury-model-of-uncontrolled-hemorrhage-improves-hemostasis
#5
Mitchell R Dyer, DaShawn Hickman, Norman Luc, Shannon Haldeman, Patricia Loughran, Christa Pawlwoski, Anirban Sen Gupta, Matthew D Neal
BACKGROUND: Clinical resuscitative treatment of traumatic hemorrhage involves transfusion of RBC, platelets and plasma in controlled ratios. However, use of such blood components, especially platelets, present many challenges including availability, portability, contamination risks, and short shelf-life, which limit the use of platelet transfusions outside of large trauma centers such as remote civilian hospitals and austere pre-hospital settings. This has prompted significant research in platelet substitutes that may resolve the above issues while providing platelet-mimetic hemostatic action...
March 12, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29520416/assessment-of-sensitivity-of-whole-body-ct-for-major-trauma
#6
Susan Yoong, Ravi Kothari, Adam Brooks
INTRODUCTION: Whole body computed tomography has become standard practice in many centres in the management of severely injured trauma patients, however, the evidence for it's diagnostic accuracy is limited. AIM: To assess the sensitivity of whole body CT in major trauma. METHOD: Retrospective review of all patients with injury severity score (ISS) > 15 presenting with blunt trauma to a UK Major Trauma Centre between May 2012 and April 2014...
March 8, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29407154/porous-chitosan-microspheres-containing-zinc-ion-for-enhanced-thrombosis-and-hemostasis
#7
Meng Pan, Zonghao Tang, Jianbing Tu, Zhengchao Wang, Qinhui Chen, Rongdong Xiao, Haiqing Liu
Quick hemostats for non-lethal massive traumatic bleeding in battlefield and civilian accidents are important for reducing mortality and medical costs. Chitosan (CS) has been widely used as a clinic hemostat. To enhance its hemostatic efficiency, Zn2+ in the form of zinc alginate (ZnAlg) was introduced to CS to make porous CS@ZnAlg microspheres with ZnAlg component on the surface. Such microspheres were prepared by successive steps of micro-emulsion, polyelectrolyte adhesion, and thermally induced phase separation...
April 1, 2018: Materials Science & Engineering. C, Materials for Biological Applications
https://www.readbyqxmd.com/read/29350370/operative-and-non-operative-management-of-children-with-abdominal-gunshot-injuries
#8
Mehmet Şerif Arslan, Hikmet Zeytun, Serkan Arslan, Erol Basuguy, Mehmet Hanifi Okur, Bahattin Aydoğdu, Cemil Göya, İbrahim Uygun, Selçuk Otçu
BACKGROUND: Non-operative management (NOM) is a standard treatment method for solid organ injuries worldwide. There is no consensus on the management of gunshot wounds (GSW) because of the higher frequency of hollow viscus injuries (HVI) and the unpredictable depth of tissue damage produced by kinetic energy transfer during retardation of the bullet. Here we aimed to reevaluate indications for surgery and NOM based on our pediatric patients with abdominal GSW. METHODS: We performed a retrospective analysis of patients evaluated and treated for abdominal GSW at University of Dicle between January 2010 and October 2016...
January 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/29259232/cardiac-depression-in-pigs-after-multiple-trauma-characterization-of-posttraumatic-structural-and-functional-alterations
#9
M Kalbitz, S Schwarz, B Weber, B Bosch, J Pressmar, F M Hoenes, C K Braun, K Horst, T P Simon, R Pfeifer, P Störmann, H Hummler, F Gebhard, H C Pape, M Huber-Lang, F Hildebrand
The purpose of this study was to define the relationship between cardiac depression and morphological and immunological alterations in cardiac tissue after multiple trauma. However, the mechanistic basis of depressed cardiac function after trauma is still elusive. In a porcine polytrauma model including blunt chest trauma, liver laceration, femur fracture and haemorrhage serial trans-thoracic echocardiography was performed and correlated with cellular cardiac injury as well as with the occurrence of extracellular histones in serum...
December 19, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29251706/valproic-acid-induces-prosurvival-transcriptomic-changes-in-swine-subjected-to-traumatic-injury-and-hemorrhagic-shock
#10
Patrick E Georgoff, Vahagn C Nikolian, Gerald Higgins, Kiril Chtraklin, Hassan Eidy, Mohamed H Ghandour, Aaron Williams, Brian Athey, Hasan B Alam
BACKGROUND: Valproic acid (VPA) is a histone deacetylase inhibitor that improves outcomes in large animal models of trauma. However, its protective mechanism of action is not completely understood. We sought to characterize the genetic changes induced by VPA treatment following traumatic injuries. METHODS: Six female Yorkshire swine were subjected to traumatic brain injury (controlled cortical impact), polytrauma (liver and splenic laceration, rib fracture, rectus crush), and hemorrhagic shock (HS, 40% total blood volume)...
April 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29201808/management-of-traumatic-liver-and-bile-duct-laceration
#11
Charu Tiwari, Hemanshi Shah, Mukta Waghmare, Kiran Khedkar, Pankaj Dwivedi
Posttraumatic major bile leak in children is uncommon, with few cases reported in the literature. These injuries are seen in high-grade liver trauma and are difficult to diagnose and manage. We describe a 7-year-old boy with grade IV hepatic trauma and bile leak following blunt abdominal trauma. The leak was successfully managed by percutaneous drainage and endoscopic retrograde cholangiopancreatography (ERCP) stenting of the injured hepatic duct. How to cite this article: Tiwari C, Shah H, Waghmare M, Khedkar K, Dwivedi P...
July 2017: Euroasian journal of hepato-gastroenterology
https://www.readbyqxmd.com/read/29156155/leukotriene-b4-indicates-lung-injury-and-on-going-inflammatory-changes-after-severe-trauma-in-a-porcine-long-term-model
#12
Philipp Störmann, Birgit Auner, Lukas Schimunek, Rafael Serve, Klemens Horst, Tim-P Simon, Roman Pfeifer, Kernt Köhler, Frank Hildebrand, Sebastian Wutzler, Hans-Christoph Pape, Ingo Marzi, Borna Relja
BACKGROUND: Recognizing patients at risk for pulmonary complications (PC) is of high clinical relevance. Migration of polymorphonuclear leukocytes (PMN) to inflammatory sites plays an important role in PC, and is tightly regulated by specific chemokines including interleukin (IL)-8 and other mediators such as leukotriene (LT)B4. Previously, we have reported that LTB4 indicated early patients at risk for PC after trauma. Here, the relevance of LTB4 to indicating lung integrity in a newly established long-term porcine severe trauma model (polytrauma, PT) was explored...
December 2017: Prostaglandins, Leukotrienes, and Essential Fatty Acids
https://www.readbyqxmd.com/read/29125848/early-decreased-tlr2-expression-on-monocytes-is-associated-with-their-reduced-phagocytic-activity-and-impaired-maturation-in-a-porcine-polytrauma-model
#13
Lukas Schimunek, Rafael Serve, Michel P J Teuben, Philipp Störmann, Birgit Auner, Mathias Woschek, Roman Pfeifer, Klemens Horst, Tim-P Simon, Miriam Kalbitz, Ramona Sturm, Hans-C Pape, Frank Hildebrand, Ingo Marzi, Borna Relja
In their post-traumatic course, trauma patients suffering from multiple injuries have a high risk for immune dysregulation, which may contribute to post-injury complications and late mortality. Monocytes as specific effector cells of the innate immunity play a crucial role in inflammation. Using their Pattern Recognition Receptors (PRRs), notably Toll-Like Receptors (TLR), the monocytes recognize pathogens and/or pathogen-associated molecular patterns (PAMPs) and organize their clearance. TLR2 is the major receptor for particles of gram-positive bacteria, and initiates their phagocytosis...
2017: PloS One
https://www.readbyqxmd.com/read/29097198/liver-lacerations-as-a-complication-of-cpr-during-pregnancy
#14
Timothy R Cox, Sarah D Crimmins, Allison M Shannon, Kristin L Atkins, Ronald Tesoriero, Andrew M Malinow
AIM: Cardiac arrest in peripartum patients is a rare but devastating event; reported rates in the literature range from 0.019% to 0.0085%. In the general population, a well-described complication of cardiopulmonary resuscitation (CPR), liver laceration and injury, is reported at a rate of between 0.5-2.9% after CPR. Liver laceration rate among peripartum patients receiving CPR has not been well-studied. We sought to find the rate of liver lacerations in the peripartum population associated with CPR, with the hypothesis that the rate would be higher than in the general population...
January 2018: Resuscitation
https://www.readbyqxmd.com/read/29064302/study-of-chest-injuries-to-3-year-old-child-occupants-seated-in-impact-shield-and-5-point-harness-crss
#15
Yong Han, Di Pan, Jun Ouyang, Lei Qian, Koji Mizuno, Anguo Cang
OBJECTIVE: The objective of this study was to investigate whether the 5-point harness or the impact shield child restraint system (CRS) or both have the potential to cause chest injuries to children. This is determined by examining whether the loading to the chest reaches the internal organ injury threshold for children. METHOD: The chest injury risk to a child occupant in a CRS was investigated using Q3 dummy tests, finite element (FE) simulations (Q3 dummy and human models), and animal tests...
April 3, 2018: Traffic Injury Prevention
https://www.readbyqxmd.com/read/29061963/%C3%AE-v-integrins-on-mesenchymal-cells-regulate-skeletal-and-cardiac-muscle-fibrosis
#16
I R Murray, Z N Gonzalez, J Baily, R Dobie, R J Wallace, A C Mackinnon, J R Smith, S N Greenhalgh, A I Thompson, K P Conroy, D W Griggs, P G Ruminski, G A Gray, M Singh, M A Campbell, T J Kendall, J Dai, Y Li, J P Iredale, H Simpson, J Huard, B Péault, N C Henderson
Mesenchymal cells expressing platelet-derived growth factor receptor beta (PDGFRβ) are known to be important in fibrosis of organs such as the liver and kidney. Here we show that PDGFRβ+ cells contribute to skeletal muscle and cardiac fibrosis via a mechanism that depends on αv integrins. Mice in which αv integrin is depleted in PDGFRβ+ cells are protected from cardiotoxin and laceration-induced skeletal muscle fibrosis and angiotensin II-induced cardiac fibrosis. In addition, a small-molecule inhibitor of αv integrins attenuates fibrosis, even when pre-established, in both skeletal and cardiac muscle, and improves skeletal muscle function...
October 24, 2017: Nature Communications
https://www.readbyqxmd.com/read/29034490/hepatic-complications-of-umbilical-venous-catheters-in-the-neonatal-period-the-ultrasound-spectrum
#17
Betul Emine Derinkuyu, Oznur Leman Boyunaga, Cagri Damar, Sezin Unal, Ebru Ergenekon, Ayse Gul Alimli, Cigdem Oztunali, Canan Turkyilmaz
OBJECTIVES: Umbilical venous catheterization is commonly used in the neonatal period; however, it has some complications. In this study, we evaluated neonates who underwent umbilical venous catheterization and developed hepatic complications. Furthermore, we aimed to define all of the possible lesions and to clarify the imaging findings of umbilical venous catheter-induced hepatic injury. METHODS: Two hundred forty-four neonates who underwent umbilical venous catheterization between March 2013 and September 2015 in a single tertiary care referral center were included in this study...
October 16, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/29033774/hemothorax-following-uncomplicated-endoscopic-variceal-sclerotherapy-and-ligation-for-esophageal-varices
#18
Tomoko Ochiai, Yukiomi Nakade, Rena Kitano, Shunsuke Kato, Kazumasa Sakamoto, Tadahisa Inoue, Yuji Kobayashi, Norimitsu Ishii, Tomohiko Ohashi, Yoshio Sumida, Kiyoaki Ito, Haruhisa Nakao, Chihiro Furuta, Motoki Yano, Masashi Yoneda
Endoscopic variceal sclerotherapy and ligation are standard treatment modalities used for the management of esophageal varices. Reportedly, sclerotherapy and ligation are associated with complications such as hematuria, pulmonary thrombus formation, pleural effusion, renal dysfunction, and esophageal stenosis. However, hemothorax following sclerotherapy and ligation has not yet been reported. We treated a patient who presented with liver cirrhosis and polycythemia vera and later developed hemothorax following the above-mentioned procedures...
September 2017: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/28975653/analysis-of-skeletal-muscle-microcirculation-in-a-porcine-polytrauma-model-with-haemorrhagic-shock
#19
Zhi Qiao, Klemens Horst, Michel Teuben, Johannes Greven, Luxu Yin, Yannik Kalbas, René H Tolba, Hans-Christoph Pape, Frank Hildebrand, Roman Pfeifer
Polytraumatised patients with haemorrhagic shock are prone to develop systemic complications, such as SIRS (systemic inflammatory response syndrome), ARDS (acute respiratory distress syndrome) and MOF (multiple organ failure). The pathomechanism of severe complications following trauma is multifactorial, and it is believed that microcirculatory dysfunction plays an important role. The aim of this study was to determine the changes in the microcirculation in musculature over time during shock and subsequent resuscitation in a porcine model of haemorrhagic shock and polytrauma...
October 3, 2017: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
https://www.readbyqxmd.com/read/28962752/chitosan-kaolin-composite-porous-microspheres-with-high-hemostatic-efficacy
#20
Xun Sun, Zonghao Tang, Meng Pan, Zhengchao Wang, Hongqin Yang, Haiqing Liu
The hemostatic performance of chitosan was greatly improved by blending it with kaolin to fabricate porous composite microspheres (CSMS-K) through inverse emulsion method combining with thermally induced phase separation. The CSMS-K had high amount of interior and surface pores. The synergetic hemostatic competence of chitosan and kaolin components made the hemostatic efficacy of CSMS-K superior to chitosan porous microspheres (CSMS). The hemostatic time of CSMS-K3 in the rat tail amputation and liver laceration models was down to respective 120 and 99s from 183 and 134s of CSMS, and the blood loss of CSMS-K3 was respectively 65% and 36% of that of CSMS in the rat tail amputation and liver laceration models...
December 1, 2017: Carbohydrate Polymers
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