The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jan 2012
A management of blunt thoracic trauma in an emergency department observation unit: pre-post observational study.
The best management of patients with isolated blunt thoracic trauma at high risk of pulmonary complications (HRPC-BTT: ≥3 isolated rib fractures, sternal fracture, single or few pulmonary contusions or minimal pneumothorax) is still unclear. We compared efficacy and cost-effectiveness of a new clinical pathway involving an Emergency Department Observation Unit (EDOU) with routine care. ⋯ In managing patients affected by HRPC-BTT, a clinical pathway involving the EDOU seems to be more effective than routine care with little impact on cost.
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J Trauma Acute Care Surg · Jan 2012
Recombinant factor VIIa is effective at reversing coagulopathy in a lactic acidosis model.
The interplay of coagulopathy, acidosis, and hypothermia contributes to the death of the most seriously injured trauma patients. Because of in vitro testing and retrospective series, current recommendations advise correcting acidosis before administering recombinant factor VII (rFVIIa). ⋯ rFVIIa is effective at reversing the coagulopathy from lactic acidosis in a large animal model. Recommendations against its use in acidotic patients may not be valid.
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J Trauma Acute Care Surg · Jan 2012
Disruption of Nrf2 exacerbated the damage after spinal cord injury in mice.
Nuclear factor erythroid 2-related factor 2 (Nrf2) is a key transcriptional factor for antioxidant response element-regulated genes. After spinal cord injury (SCI), the Nrf2-antioxidant response element pathway is activated in the spinal cord. However, the function of Nrf2 after SCI has not yet been studied. ⋯ Genetic ablation of Nrf2 exacerbated the neurologic deficit and inflammation after SCI in mice. These findings raise the possibility that Nrf2 could be relevant in improving outcome after SCI.
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J Trauma Acute Care Surg · Jan 2012
Enoxaparin and fondaparinux attenuates endothelial damage in endotoxemic rats.
Prophylactic use of anticoagulants for septic patients in intensive care unit is a standard therapy for the prevention of venous thrombosis. Moreover, recent studies have demonstrated the anti-inflammatory effects of anticoagulants such as Factor Xa inhibitors and heparins. However, there have been no studies to examine the effects of fondaparinux and enoxaparin when applied in a sepsis model. Therefore, we examined the anti-inflammatory effects and bleeding events when these agents are applied in a lipopolysaccharide challenge model. ⋯ Fondaparinux and enoxaparin reduce organ dysfunction by decreasing endothelial damage. However, bleeding was more prominent in the fondaparinux group compared with the enoxaparin group at an equipotent dose for anti-Xa activity. Because the setting of this experiment is different from the clinical use, further study is required for the comparison of both pharmaceuticals.
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J Trauma Acute Care Surg · Jan 2012
Ulinastatin protects pulmonary tissues from lipopolysaccharide-induced injury as an immunomodulator.
Organ protection is a routine therapy in patients with severe trauma, infection, and even multiple organ dysfunction syndrome. Appropriate inflammatory response benefits organ function with sepsis. Our aim was to verify the immunoregulatory effects of Ulinastatin (UTI) on lipopolysaccharide (LPS) administrated mice. ⋯ Our results demonstrated that UTI reduced LPS-induced pulmonary injury. The mechanism of its action might involve the immunoregulation and the mitigation of excessive inflammatory reaction.