J Trauma
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Neer IIB distal clavicle fracture is associated with disruption of the coracoclavicular ligament and a variable degree of displacement. Surgical treatment using various implants such as intramedullary wires, screws, and plates has been described in the literature with satisfactory results. ⋯ Minimally invasive surgery using titanium cable seems to be a good option for the treatment of Neer IIB distal clavicle fractures, with early functional recovery and no requirement for revision surgery.
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Nanofibers consisting of poly-N-acetyl glucosamine (pGlcNAc), as the functional component of products for surface hemostasis, have been shown to activate platelets and thereby the clotting mechanism. The nanofiber-activated platelets provide a catalytic surface for acceleration of the intrinsic coagulation cascade, thrombin generation, and fibrin polymerization. ⋯ These results provide evidence that pGlcNAc nanofibers activate platelets and accelerate the clotting of blood, and on how best to achieve surface hemostasis when patients are coagulopathic because of shock and/or to treatment with antiplatelet drugs.
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Laboratory studies demonstrate gender dimorphism following trauma/hemorrhagic shock (T/HS). These differences have been attributed to estrogen (E2) levels. Maintenance of gut barrier function by E2 following T/HS has been recently described. However, the mechanisms are not clear. The principle humoral defense mechanism of the gut is provided by secretory immunoglobulin IgA. It is transported across intestinal epithelial cells (IEC) by a specific transmembrane protein receptor (polyimmunoglobulin receptor, pIgR). Transport of IgA (transcytosis) may be influenced by a number of factors. We postulated that there may be differences in IgA transcytosis and IEC pIgR expression in response to sex hormones. We studied this in vitro. ⋯ IgA transcytosis was augmented by E2 in a dose-response fashion. This effect was due to augmented intracellular trafficking of IgA and later partly due to increased pIgR expression. The dose-related effects of E2 on IgA transport confirm the findings in animal studies that improved outcomes in females can be related to the estrus cycle.
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Validation of the IMPACT outcome prediction score using the Nottingham Head Injury Register dataset.
Comparison of traumatic brain injury (TBI) outcomes is severely limited by the absence of a universally accepted and validated outcome prediction score. The IMPACT group recently reported models predicting mortality and unfavorable outcome after TBI, based on the outcomes of patients with moderate and severe head injury reported in two large clinical trials. ⋯ The 2005 IMPACT model for unfavorable outcome performs well when used to predict outcome in adults with moderate and severe TBI presenting to a British neurosurgical center. However, the model for mortality fitted less well, slightly overestimating mortality in the higher-risk groups.
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It has been previously demonstrated that short-fiber poly-N-acetyl-glucosamine (sNAG) nanofibers specifically interact with platelets, are hemostatic, and stimulate diabetic wound healing by activating angiogenesis, cell proliferation, and reepithelialization. Platelets play a significant physiologic role in wound healing. The influence of altered platelet function by treatment with the ADP inhibitor Clopidogrel (CL) on wound healing and the ability of sNAG to repair wounds in diabetic mice treated with CL were studied. ⋯ CL treatment of diabetic mice decreased angiogenesis and increased cell proliferation in wounds but did not influence macroscopic wound healing kinetics. sNAG treatment did not inhibit angiogenesis in CL-treated mice and induced faster wound closure; sNAG technology is a promising strategy to facilitate the healing of complex bleeding wounds in CL-treated diabetic patients.