The Journal of surgical research
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Training of surgical residents depends on graduated autonomy in and out of the operating room. We sought to define trends in operative volume and number of teaching cases in graduating surgical residents over time. ⋯ Despite a relative stability of case volume over time, GSRs are graduating with relatively few cases recorded as TA. Improved opportunities for trainees to take on the role of TA while in residency may lead to improved confidence as surgeons on graduation.
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Ischemia-reperfusion injury caused by severe hemorrhagic shock and subsequent resuscitation leads to deterioration of hepatic homeostasis and possibly to liver failure. The present study focuses on determining whether there is a different biological response to hemorrhagic shock by different sources of hemorrhage, hepatic hemorrhage (HH) versus peripheral hemorrhage. ⋯ Our study provides evidence that HH entails worse consequences for the hepatocytes than systemic hemorrhage. Higher needs for resuscitation fluids, decreased proliferation, and augmented inflammatory response when HH takes place are findings with possible clinical importance in liver surgery and trauma.
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Urgent tracheal intubation is common in intensive care units and the emergency room, and succinylcholine is a first-line neuromuscular blocker used in these situations. Paraplegic or critically ill patients may be at a high risk of receiving succinylcholine because the denervation stage changes nicotinic receptors, which affect the efficacy and safety of succinylcholine. The objective of this study was to determine the receptor subtypes associated with changes in the pharmacodynamics of succinylcholine and its time-line trend. ⋯ Nerve injury may alter nicotinic AChR subtypes in skeletal muscle at different stages, which probably affected the pharmacodynamics of neuromuscular blockers in different ways. Denervation time and stage and the type of neuromuscular blocker and dosage should be taken into consideration when using these drugs in patients with nerve injury.
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Traumatic brain injury (TBI) is often associated with uncontrolled hemorrhagic shock (UHS), which contributes significantly to the mortality of severe trauma. Studies have demonstrated that permissive hypotension resuscitation improves the survival for uncontrolled hemorrhage. What the ideal target mean arterial pressure (MAP) is for TBI with UHS remains unclear. ⋯ A 50-mm Hg target MAP is not suitable for the resuscitation of TBI combined with UHS. A 70 mm Hg of MAP is the ideal target resuscitation pressure for this trauma, which can keep sufficient perfusion to the brain and keep good organ function including cerebral mitochondrial function.
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Ketamine, a noncompetitive N-methyl-D-aspartate receptor antagonist, is widely used as an intravenous anesthetic agent and has also been shown to possess anti-inflammatory effects, but its effects on high-mobility group box-1 (HMGB1) have not been well defined. In the present study, we investigated the effects of ketamine on HMGB1 in lipopolysaccharide (LPS)-induced Raw264.7 cells and in a mouse model of cecal ligation and puncture-induced sepsis. ⋯ Ketamine inhibits LPS-induced HMGB1 release through HO-1 induction, and these effects may be mediated by blockade of p38 MAPK and Nrf2 signaling pathways.