Articles: trauma.
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The choice of an ideal fluid administered post trauma and its subsequent influence on coagulation still poses a clinical dilemma. Hence, this study was designed to assess the influence of in vivo hemodilution with various fluid preparations (4% gelatin, 6% hydoxyethyl starch (HES), Ringer's lactate, 0.9% normal saline) on coagulation using standard coagulation parameters and real-time thromboelastography (TEG) in patients undergoing elective surgery post trauma. ⋯ Crystalloids are optimal volume expanders in trauma, with RL having beneficial effects on coagulation system (decrease in k time and increase in MA and A20). Among the colloids, HES 6% (130/0.4) affects coagulation parameters (increase in PTI, INR, R time, k time) more than gelatin. Trial registration (protocol number-IEC/NP-189/2011).
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Front Bioeng Biotechnol · Jan 2013
ReviewA Systems Engineering Perspective on Homeostasis and Disease.
Engineered systems are coupled networks of interacting sub-systems, whose dynamics are constrained to requirements of robustness and flexibility. They have evolved by design to optimize function in a changing environment and maintain responses within ranges. Analysis, synthesis, and design of complex supply chains aim to identify and explore the laws governing optimally integrated systems. ⋯ Our increasing understanding of life's multi-scale architecture suggests that living systems share similar characteristics with much to be learned about biological complexity from engineered systems. If health reflects a dynamically stable integration of molecules, cell, tissues, and organs; disease indicates displacement compensated for and corrected by activation and combination of feedback mechanisms through interconnected networks. In this article, we draw analogies between concepts in systems engineering and conceptual models of health and disease; establish connections between these concepts and physiologic modeling; and describe how these mirror onto the physiological counterparts of engineered systems.
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To determine military-specific cervical neurovascular and external anthropometric data to scale future numerical injury models of the neck and improve body armour design with a view to prevention or mitigation of combat neck injury. ⋯ Future cervical anthropometric assessments should use the vertical angle of mandible to mid-claviclular distance in combination with the horizontal neck circumference as these demonstrated the least variability. Cervical neurovascular structures are least vulnerable posterosuperiorly and therefore extending the posterior aspect of a ballistic helmet inferiorly or adding a nape protector would appear to be less justified. Cervical vessels are most vulnerable in zone 1 and a circumferential collar of ballistic material at least 75 mm high would cover this area in 95% of this population.
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Detection of occult injuries, which are not easily recognized and are life-threatening, in motor vehicle crashes (MVCs) is crucial in order to reduce fatalities. An Occult Injury Database (OID) was previously developed by the Center for Transportation Injury Research (CenTIR) using the National Automotive Sampling System Crashworthiness Data System (NASS-CDS) 1997-2001 which identified occult and non-occult head, thorax, and abdomen injuries. The objective of the current work was to develop an occult injury model based on underlying injury characteristics to derive an Occult Score for common MVC-induced injuries. ⋯ Of the considered injuries, it was determined that 54% of head, 26% of thorax, and 23% of abdominal injuries were occult injuries. No occult injuries were identified in the face, spine, upper extremity, or lower extremity body regions. The Occult Score generated can be useful in advanced automatic crash notification research and for the detection of serious occult injuries in MVCs requiring prompt treatment at a trauma center.