The Journal of surgical research
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Splanchnic ischemia is common in critically ill patients, and it can result in injury not only of the intestine but also in distant organs, particularly in the lung. Local inflammatory changes play a pivotal role in the development of acute lung injury after intestinal ischemia, but the underlying molecular mechanisms are not fully understood. We sought to examine the role of Toll-like receptor 4 (TLR4) in the mouse model of intestinal ischemia-reperfusion (I/R)-induced lung injury and inflammation. ⋯ These data suggest that TLR4 plays an important role in the pathogenesis of intestinal I/R-induced acute lung injury and inflammation and that p38 kinase and NF-κB may be involved in TLR4 signaling-mediated lung inflammatory processes during intestinal I/R.
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Comparative Study
Diagnostic values of a single serum biomarker at different time points compared with Alvarado score and imaging examinations in pediatric appendicitis.
A large number of children with right lower quadrant pain are evaluated on a daily basis by primary care clinicians in order to rule out acute appendicitis. The aim of this study was to determine the cutoff values of serum biomarkers, including white blood cell (WBC) count and C-reactive protein (CRP) in predicting pediatric appendicitis based on how long the patients' symptoms were present. We further compared the diagnostic values of these serum biomarkers with the Alvarado score and imaging examinations. ⋯ A single serum biomarker at different time points has a favorable diagnostic value, which is inexpensive, objective, and readily available without the risk of radiation or the need of sedation and is useful for primary caregiver.
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Orthopedic surgeons are reluctant to perform total knee (TKA) or hip (THA) arthroplasty on patients with high body mass index (BMI). Recent studies are conflicting regarding the risk of obesity on perioperative complications. Our study investigates the effect of BMI on perioperative complications in patients undergoing TKA and THA using a national risk-adjusted database. ⋯ Our study demonstrates no statistical difference in perioperative complication rates in patients undergoing TKA or THA across BMI categories. Performing TKA or THA on patients with high BMI may increase mobility leading to improved quality of life.
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Surgical wound classification has been the foundation for infectious risk assessment, perioperative protocol development, and surgical decision-making. The wound classification system categorizes all surgeries into: clean, clean/contaminated, contaminated, and dirty, with estimated postoperative rates of surgical site infection (SSI) being 1%-5%, 3%-11%, 10%-17%, and over 27%, respectively. The present study evaluates the associated rates of the SSI by wound classification using a large risk adjusted surgical patient database. ⋯ Using ACS-NSQIP data, the present study demonstrates substantially lower rates of surgical site infections in the contaminated and dirty wound classifications than previously reported in the literature.
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The understanding of coagulopathy associated with trauma continues to evolve. Trauma patients are frequently coagulopathic early after injury and become hypercoagulable within days of injury. Thrombelastography (TEG) allows real-time evaluation of the coagulation status of patients. We hypothesized that TEG will identify post-traumatic hypercoagulable state in our porcine model of hemorrhagic shock and resuscitation. ⋯ Hypercoagulability is present early after surgical intervention and trauma. This finding has implications for use of deep venous thrombosis (DVT) prophylaxis in trauma patients.