J Trauma
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: Motor vehicle crashes are the leading cause of death among teenagers because of higher crash rates per mile driven and low seat belt use rates. ⋯ : Social pressure and poor comprehension of the risks of injury were identified as barriers to seat belt usage among teenage high school students. A friendly, competitive approach to openly discussing and educating teens about these risks led to a 20% increase in seat belt usage among teen drivers and their passengers.
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: Hypothermia after trauma is, in current medical practice, both avoided and aggressively treated. However, the effects of environmental hypothermia during early resuscitation after hemorrhagic shock have been only poorly characterized. ⋯ : In our porcine model, we found that simulating mild and severe levels of environmental hypothermia during early resuscitation after hemorrhage was associated with a significantly decreased mortality rate. Furthermore, markers of cellular stress and organ dysfunction, including lactate levels and the base deficit, were lower in hypothermic animals. Decreasing oxygen consumption with hypothermia may, in part, explain the protective effects observed with hypothermia.
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: Previous studies indicate that age, Glasgow Coma Scale score (GCS), arterial hypotension, computed tomography (CT) findings, and pupillary reactivity are strong predictors of outcome for patients with severe traumatic brain injury (TBI). However, the predictive validity of these variables has never been rigorously tested in patients from the developing world. The objective of this study was to evaluate the prognostic value of these variables in a resource-limited setting and to test their predictive power by using them to create an outcome model. ⋯ : This study provides rigorous, prospective data that (1) validates the generalizability of the five World Health Organization/Organization Mondiale de la Santé TBI prognostic predictors outside of the developed world, and (2) provides outcome benchmarks for mortality and morbidity from severe TBI in developing countries.
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Controlled Clinical Trial
Spleen artery embolization aggravates endotoxin hyporesponse of peripheral blood mononuclear cells in patients with spleen injury.
: Spleen artery embolization (SAE) increases the success of nonoperative management of spleen injury; however, the immune alternation after SAE is unclear. This study searched the endotoxin responses of peripheral blood mononuclear cells (PBMCs) in injured patients who received SAE. ⋯ : SAE dysregulates the NF-kB system and aggravates the cytokine hyporesponse upon ES of PBMCs in patients with spleen injury. These results implicate that SAE alters immune response and may increase susceptibility to infections in injured patients.