J Trauma
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Despite substantial improvements in trauma care, severe injuries often result in significant long-term consequences for otherwise young, healthy individuals. Providing patient-centered care and extensive psychosocial support services is difficult for trauma centers. ⋯ The Trauma Survivors Network provides a critical component of trauma care that can be adapted for local needs throughout the country. Implementation of these services is a necessary step in the development of comprehensive trauma systems that not only save lives but also reduce long-term disability among survivors.
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The authors investigated poly(lactide-co-glycolide) (PLGA) capsule and collagen composite system for antibiotics and bone cells delivery to treat infected bone defects. Poly(lactide-co-glycolide) was mixed with vancomycin and hot compressing molded to form an antibiotic capsule. Rabbit mesenchymal stem cells (MSCs) were entrapped in collagen gel phase and dispersed throughout the void volume of capsule. ⋯ Sample inhibition zone was 9 mm to 24 mm, and the relative activity was 11.8% to 100%. Implanted PKH 26-labeled MSCs were identified in the newly formed bony trabeculae in specimens at 2 and 4 months after implantation. The results offer a potential approach to meet clinical requirements in the treatment of infected bone defects.
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Reduced heart rate variability (HRV) reflects autonomic dysfunction and can triage patients better than routine trauma criteria or vital signs. However, there is questionable specificity and no consensus measurement technique. The purpose of this study was to analyze whether factors that alter autonomic function affect the specificity of HRV for assessing traumatic injury. ⋯ Decreased VLF is an independent predictor of mortality and morbidity in hemodynamically stable trauma patients. Other time and other frequency domain variables correlated with some, but not all, outcomes. All were heavily influenced by factors that alter autonomic function, especially patient age.
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Age is suggested as a triage criteria for transfer to a trauma center, despite poor outcomes after similar injury regardless of trauma center level. The effect of differential triage based on age to a trauma center has not been evaluated. We hypothesized that there would be a difference in the admission rates of geriatric patients compared with the rest of the adult trauma population independent of injury severity. ⋯ Age alone is associated with increased odds of being admitted to the hospital, independent of injury severity and other physiologic parameters. This has implications for trauma centers that see a significant proportion of geriatric trauma patients and for trauma systems that must prepare for the "aging of America."