J Trauma
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Endothelial nitric oxide synthase (eNOS) -786T→C and 894G→T polymorphisms have been associated with eNOS dysfunction, which might further compromise microcirculatory blood flow during sepsis and increase the risk of organ injury. The purpose of this study is to investigate the association of those two eNOS gene polymorphisms with the severity of organ dysfunction and outcome in patients with severe sepsis. ⋯ Carriage of the GT genotype at 894 of eNOS gene was associated with the occurrence of shock and impaired organ function.
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Patients with spinal cord injury (SCI) are at particular risk for deep vein thrombosis (DVT) during their hospital course. In most researches on the prevention of thromboembolic events after SCI, the cause of SCI was usually limited to traumatic origin, and pharmaco-prophylaxis was usually started immediately after SCI irrespective of the presence of DVT. For this reason, it is difficult to determine the exact incidence of DVT after SCI from all possible causes in the absence of anticoagulation treatment. We sought to determine the incidence of DVT and the effect of mechanical treatments without chemical prophylaxis. ⋯ The incidence of DVT in patients with SCI routinely given mechanical prophylaxis without anticoagulation was higher when compared with those reported in the setting of routine pharmaco-prophylaxis. Anticoagulation should not be excluded from initial DVT prophylaxis measures in the SCI patients unless there is any ongoing bleeding or severe coagulopathy. Further studies will be necessary to get a more precise data and to understand the clinical relevance of these results.
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Wound excision is the standard treatment for firearm wounds. However, achieving a satisfactory curative effect is difficult because of the traumatic mechanism of high-velocity projectiles. We propose a new therapy by using topical bromelain as a supplement to wound incision for the debridement of firearm wounds. We clarified the debriding effect of bromelain on firearm wounds in pigs. ⋯ Bromelain is effective in the debridement of uncomplicated firearm wounds if used as a supplement to simple wound incision. This new therapy shows notable advantages over conventional surgical debridement as it greatly simplifies the procedures.
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Traumatic pneumomediastinum secondary to blunt chest injury in children is concerning for potential life-threatening tracheobronchial, esophageal, or vascular thoracic injuries. These patients often undergo extensive radiologic evaluation and invasive testing due to the unclear risk of traumatic pneumomediastinum. ⋯ Tracheobronchial, esophageal, or vascular thoracic injuries were uncommon in children with traumatic pneumomediastinum and occurred in the setting of additional thoracic and other organ system injuries. Pneumomediastinum without radiographic or clinical evidence of other thoracic injuries may not routinely require further diagnostic testing.
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The severity of renal dysfunction correlates with fatal outcome after hemorrhagic shock. However, the precise mechanism for increasing renal dysfunction in response to the degree and the progression of hemorrhagic shock has not been clearly demonstrated. In this study, we examined the role of p38 mitogen-activated protein kinase (MAPK) activation on the progression of renal dysfunction by studying the differential severity of bleeding. ⋯ The increase of initial p38 MAPK activation after hemorrhagic shock quantitatively enhanced the ensuing renal dysfunction in response to the degree and the progression of hemorrhagic shock.