Injury
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Blast injuries include the various types of internal and external trauma caused by the impact force of high-speed blast waves with multiple mechanisms involved. Thoracic blast exposure could induce neurotrauma as well, but effective therapies are lacking. Resveratrol is a polyphenol flavonoid secreted by plants and has been shown to provide cardiovascular protection and play anti-inflammatory, anti-oxidation and anti-cancer roles. ⋯ In brain tissue, resveratrol significantly attenuated thoracic blast exposure-induced generation of ROS and expressions of IRE-α and CHOP, lowered the expressions of Bax and p53, and maintained Bcl-2 expression (P < 0.05). Additionally, resveratrol significantly ameliorated thoracic blast exposure-induced increases of Kelch-like ECH-associated protein 1 (Keap1) and nuclear factor (NF)-κB and the decrease in nuclear factor erythroid 2-related factor 2(Nrf2) expression in the brain (P < 0.05). Our results indicate that resveratrol has a protective effect on thoracic blast exposure-induced brain injury that is likely mediated through the Nrf2/Keap1 and NF-κB signaling pathways.
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Randomized Controlled Trial
Intramedullary nail versus bridge plate in open tibial fractures - randomized clinical trial.
Open tibial shaft fractures present a challenge to the orthopedic surgeon, because they are common, have a high rate of complications and still have a controversial treatment. As a result of the high incidence of these fractures, the need of a definitive treatment and the unavailability of the intramedullary nail or a well-trained team, we developed this study to compare the effectiveness of the bridge-plating (BP) with the unreamed intramedullary nail (UIMN) in the treatment of open tibial shaft fractures. ⋯ We concluded that both methods were effective for the treatment of open tibia shaft fractures, however, the implant failure rate was higher in the bridge plate group.
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Randomized Controlled Trial
New versus old: 95 degree angled blade plate versus distal femoral locking plate. A randomized clinical trial.
The purpose was to compare the locking condylar plate (LCP) with the 95° angled blade plate (ABP) for distal femoral fracture patterns amenable to either device. Our hypothesis was that LCP would outperform ABP with primary outcome of nonunion and secondary outcomes of reoperation and malunion. ⋯ The investigation failed to support newer technology being better. Evidence did not indicate the LCP was superior to the ABP. Trends for primary union and fewer secondary procedures suggest that ABP may have superior performance to LCP for fracture patterns which may be treated with either implant.
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Randomized Controlled Trial
Is preoperative balloon aortic valvuloplasty of interest for severe aortic stenosis in hip fracture surgery?
In elderly patients, the discovery and management of a severe aortic stenosis (AS) prior to emergency non-cardiac surgery is a frequent and controversial issue. The objective of this study was to evaluate preoperative balloon aortic valvuloplasty (BAV) for severe AS in hip fracture surgery. ⋯ preoperative BAV for severe AS could reduce the mortality of hip fracture patients despite an increase in time to operation. This improved survival could be linked to the decrease in cardiologic and neurologic adverse events. A larger prospective randomized study is necessary before generalizing our results.
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Randomized Controlled Trial
Retrievable inferior vena cava filter for primary prophylaxis of pulmonary embolism in at-risk trauma patients: A feasibility trial.
To determine if insertion of rIVCF for PE prophylaxis in high risk trauma patients could result in a clinically meaningful reduction (>24 h) in time that patients are left unprotected from PEs SUMMARY AND BACKGROUND DATA: Trauma patients are at high risk for the development of pulmonary embolism (PE). Early pharmacologic PE prophylaxis is ideal, however many patients are unable to receive prophylaxis due to concomitant injuries. Current guidelines are conflicting on the role of prophylactic retrievable inferior vena cava filters (rIVCF) for PE prevention in this patient population, and robust data to guide clinicians is lacking. ⋯ Level 1 Evidence randomized controlled trial.