J Trauma
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It has been reported that cocaine is associated with trauma patients at epidemic proportions. However, the injury patterns, complications, and mortality in cocaine test-positive trauma patients are not well known. ⋯ Cocaine abuse in trauma patients is concerning. This study did not show a difference in mortality or length of intensive care unit stay between cocaine positive and negative patients. However, there was a significantly higher incidence of pneumonia in cocaine positive patients. Implementation of effective prevention strategies may help reduce cocaine related victims of trauma.
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Cervical spine (c-spine) injuries (CSI) in trauma patients are common and potentially catastrophic. Numerous guidelines involving clinical and radiologic criteria have been devised to diagnose such injuries. It is not clear whether using plain X-ray films in addition to helical computed tomography (CT) provides any additional benefit in trauma patients who require radiologic clearance of their c-spine. We hypothesized that three standard X-ray views (anteroposterior, lateral, and odontoid) of the c-spine do not provide clinically significant advantage to Multidetector row CT in diagnosing CSI in trauma patients. ⋯ Three standard X-ray views of the c-spine provided no clinically significant advantage to Multidetector row CT in diagnosing CSI. Revision of current clinical guidelines on c-spine clearance is recommended.
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Although some predictive models for patient outcomes after severe traumatic brain injury have been proposed, a mathematical model with high predictive value has not been established. The purpose of the present study was to analyze the most important indicators of prognosis and to develop the best outcome prediction model. ⋯ Our predictive model based on age, absence of light reflex, presence of extensive subarachnoid hemorrhage, intracranial pressure, and midline shift was shown to have high predictive value and will be useful for decision making, review of treatment, and family counseling in case of traumatic brain injury.
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Endotoxemia usually causes significant morbidity and mortality, and treatment of endotoxemia is often ineffective. The effects of tetrandrine (a bisbenzylisoquinoline alkaloid) on lipopolysaccharide (LPS)-induced endotoxemia were investigated in mice. ⋯ Tetrandrine treatment either 1 hour before or 1 hour after LPS injection reduced the mortality rate of the mice with LPS-induced endotoxemia. The effects of tetrandrine on LPS-induced endotoxemia might be related to the suppression of TNF-alpha, IL-1beta, and HMGB1 concentrations.
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Alpha-melanocyte stimulating hormone (alpha-MSH) is a neuropeptide which modulates inflammation. Prior studies have documented decreased alpha-MSH concentrations in patients with acute traumatic brain injury and subarachnoid hemorrhage. We hypothesized that alpha-MSH levels would be decreased in critically injured patients and that this would correlate with poor outcome. ⋯ The current study is the first to document significantly decreased alpha-MSH concentrations in critically injured trauma patients as compared with controls. Furthermore, alpha-MSH concentrations remained so throughout the study period.