Clin Lab
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One of the most severe conditions specific to the critically ill polytrauma patient is traumatic brain injury and traumatic spinal cord injury. The mortality rate is high in the case of these patients, both because of the direct traumatic lesions, and because of the pathophysiological imbalances associated with trauma. Amongst the most common pathologies associated with the critically ill polytrauma patients responsible for a lower survival rate, are redox imbalance, systemic inflammatory response, infections, and multiple organ dysfunction syndrome. ⋯ A new era for biomarkers is represented by the expression of miRNAs. In the case of the critically ill polytrauma patient, using miRNAs' expression as biomarkers for the evaluation and monitoring of the molecular and pathophysiological dysfunctions can bring a range of valuable answers that could contribute to an increased survival rate.
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Acute appendicitis is the most common surgical emergency in pediatrics. In this study, we aimed to evaluate the diagnostic value of D-dimer in differentiating between simple and other severe acute appendicitis in children combined with white blood cell (WBC) count, neutrophil percentage, and C-reactive protein (CRP). ⋯ CRP and D-dimer levels are positively correlated with the severity of acute appendicitis in children. Combined CRP and D-dimer are identified as suitable diagnostic markers for differentiating between simple and other severe appendicitis, which will provide important guidance for clinicians to determine the follow-up management of acute appendicitis.
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The critically ill polytrauma patient, apart from the primary, traumatic injuries and the secondary, port-traumatic injuries, presents with a series of molecular disasters. Dysfunctions of the biochemical pathways and molecular damage add to the worsening of the clinical status of these patients, one of the most well-known molecular phenomena being oxidative stress (OS), responsible for an escalation of the inflammatory status, multiple infections, and multiple organ dysfunction syndrome (MODS). ⋯ One of the most aggressive redox mechanisms related to lipid molecules is known as lipid peroxidation (LPOX).
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A high percentage of critically ill polytrauma patients develop acute respiratory distress syndrome (ARDS), both because of the primary traumatic injuries and because of the secondary post-traumatic injuries. For adequate management of these patients, new complex evaluation and monitoring methods are needed, methods that could answer as many questions as possible regarding the pathophysiological changes associated with ARDS. Currently, a series of clinical and biochemical markers are being used which unfortunately do not respond to the needs of an intensive care clinician. Therefore, the changes of miRNAs have been intensely researched in the case of patients with ARDS. Moreover, using them as biomarkers for ARDS brings a series of answers regarding the pathophysiological changes associated to ARDS, making them biomarkers of the future in laboratory medicine. ⋯ Using miRNAs for the evaluation and monitoring of ARDS makes them a biomarker of the future, because of the complex answers they bring to questions related both to the main injury caused by ARDS and to the associated pathophysiology.
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The multiple-traumatic critical patient presents a variety of pathophysiological, cellular, and molecular dysfunctions. One of the most important is represented by mitochondrial damage which afterwards is responsible for the augmentation and worsening of a series of pathologies that lead to the worsening of the clinical status of the patient. The severe inflammatory response, sepsis, and the redox imbalance are other pathologies that together with the multiple traumas are responsible for the mitochondrial dysfunctions. As an overview, we can say that both the mitochondrial damage as well as the clinical statuses of those patients are responsible for an increase in the chances of multiple organ dysfunction syndrome and death of critical patients with multiple trauma from the Intensive Care Units (ICU). In this paper we wish to summarize the microRNAs that can be used as biomarkers for evaluation and monitoring of the mitochondrial activity in critical patients with multiple traumas. ⋯ The critical polytrauma patient needs a specific evaluation and monitoring due to the complexity of the dysfunctions that appear at the cellular level. The use of microRNAs as biomarkers for the mitochondrial damage can be of real use for intensive care medicine. Nevertheless, more studies are required in order to determine a larger panel of microRNAs which can have an impact on mitochondrial damage.