The Journal of surgical research
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Increasing data indicate treatment with beta blockers might improve survival after traumatic brain injury (TBI); the optimal heart rate (HR) range for these patients is unknown. To guide treatment, admission HR in moderate to severe TBI patients was analyzed to determine if a specific range is associated with decreased mortality. ⋯ After isolated moderate to severe TBI, HR <50, 50-59, 60-69, and > or =110 were independent predictors of increased mortality. HR outside the range 70-109 could serve as a marker for aggressive resuscitation. As mortality increased significantly with HR: <50 (AOR 4.70), 50-59 (AOR 2.21), and 60-69 (AOR 1.63), our findings recommend avoiding HR < 70 in patients with moderate to severe TBI.
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Randomized Controlled Trial
A randomized control trial of levobupivacaine, bupivacaine versus placebo extraperitoneal infusion in totally extraperitoneal laparoscopic inguinal hernioplasty.
Totally extraperitoneal (TEP) laparoscopic inguinal hernioplasty procedure is significantly less painful than open repair, but it is not completely painless. The aim of this study was to compare the effect of extraperitoneal infusion of 0.25% levobupivacaine, 0.25% bupivacaine, and placebo in patients undergoing TEP procedure in terms of pain reduction. ⋯ Extraperitoneal infusion 40 mL of 0.25% bupivacaine or 0.25% levobupivacaine following TEP procedure did not show any benefit over placebo in terms of pain reduction.
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The alteration of brain extracellular glucose after enteral nutrition (EN) remains unclear. In this study, we used brain microdialysis methods to estimate whether the physiologic elevation of plasma glucose following EN affects brain glucose metabolism of aneurysmal subarachnoid hemorrhage (SAH) patients. ⋯ Brain extracellular glucose increased after the transient elevation of plasma glucose following EN. These results suggest that brief, physiologic elevations in plasma glucose after EN produced no changes in brain extracellular glutamate concentration or lactate/pyruvate ratio. These data may help determine the plasma glucose levels most effective for avoiding brain metabolic acidosis in patients after SAH. It remains unclear, however, how SAH itself influences these findings.
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Neutrophil sequestration plays an important role in mediating local and remote organ injury induced by ischemia and reperfusion (I/R). The Glu-Leu-Arg (ELR)-CXC subfamily of chemokines, all CXCR1 or CXCR2 ligands, are primary agonists for such neutrophil recruitment. Herein, we assessed the effects of a combined CXCR1/CXCR2 antagonist, CXCL8((3-72))K11R/G31P (G31P), on neutrophilic local (gut) and distant organ injury and outcomes after superior mesenteric artery I/R in rats. ⋯ These results suggest that full-spectrum ELR-CXC chemokine antagonism has significant protective effects against I/R-induced local and remote organ injury.
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The cellular processes that contribute to cell death in burns are poorly understood. This study evaluated the distribution and extent of apoptosis in an established rat model of acute dermal burn injury. ⋯ This study is the first to demonstrate that apoptosis rate is dependent on dermal location, cell type, and severity of thermal injury. Furthermore, this work suggests that for most dermal locations increased thermal injury corresponds with decreased apoptosis and increased cell injury/necrosis. Together, these findings indicate that many parameters can regulate apoptosis in burn wounds, and these results will be critical to understanding burn pathogenesis and assessing future therapies.