Missouri medicine
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As technology and medical care improve, older patients will be more active and productive at later ages. Falls and motor vehicle crashes will remain major mechanisms of injury in the elderly. Treatment of the elderly trauma patient must focus on their complex acute medical needs, their rehabilitation and social needs post trauma, and most of all prevention.
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The treatment of sepsis and septic shock is an important clinical problem. While effective antibiotic intervention and strong supportive care have improved survival, mortality remains at unacceptable levels. ⋯ The available evidence would support the conclusion that microbial mediators can function synergistically in the induction of host inflammation, providing a potential explanation that anti-endotoxin and anti-inflammatory agents have not been particularly successful in clinical trials to treat septic shock. The identification of specific recognition molecules on the surface of inflammatory mediator cells responsible for initiation of signal transduction, as well as the elucidation of the specific molecular pathways leading to gene expression, provide new opportunities for the development of effective intervention strategies for treatment of septic shock.