J Trauma
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Skull radiography is widely used to screen for fractures in patients with mild head injury. However, the clear depiction of a fracture requires a gap in the skull separated by the fracture that is wide enough to allow the passage of x-rays. We studied atypical linear fractures that were not visualized clearly, because a specific anatomical configuration hampered the passage of x-rays. ⋯ Radiographic study returned false-negative results, because x-rays were absorbed by the double-layered skull along fractures whose cross section was oblique to the direction of the x-rays. The evaluation of head injury by radiography only may miss these fractures and their undetected presence may result in sequelae such as intracranial hematoma.
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Peripheral nerve injury causes serious problems in orthopedic and plastic surgeries. Cell adhesion molecules such as integrin alpha7 provoke cell binding and signaling pathways within myofibers. Expression profiles of integrin alpha7 signaling pathways and the molecule's microscopic structure were assessed to investigate the long-term dynamic changes in denervated rat skeletal muscle. ⋯ Our novel finding showed that time-series alterations of integrin alpha7 signaling molecules and surface microstructures in the long-term denervated rat skeletal muscle are biphasic and coherently dynamic. Persisted p-Akt elevation suggested that denervated muscle may regenerate if reinnervation or other treatment was performed.
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Indications for direct transport may be strongly related to risk of future health outcomes, and these indications may not be adequately controlled by considering only in-hospital variables. This study was designed to identify prehospital factors associated with directness of transport. ⋯ Confounding due to unadjusted prehospital factors may be present in studies evaluating the impact of directness of transport on short-term mortality outcomes. Propensity score analysis of treatment indications provides an additional and efficient method to reduce this bias.
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A transthoracic focused rapid echocardiographic evaluation (FREE) was developed to answer specific questions about treatment direction regarding the use of fluid versus ionotropes in trauma patients. Our objective was to evaluate the clinical utility of the information obtained by this diagnostic test. ⋯ IVC diameter and IVC respiratory variation was able to be obtained in the majority of cases, giving an estimate of fluid status. Estimation of ejection fraction was useful in guiding the treatment plan regarding the requirement of fluid boluses versus ionotropic support. We conclude that the FREE can provide meaningful data in difficult to image critically ill trauma patients.
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The role of clinical examination in the diagnosis of thoracolumbar (TL) spine injuries is highly controversial. The aim of this study was to assess the sensitivity and specificity of a standardized clinical examination for diagnosing TL spine injuries after blunt trauma. ⋯ Clinical examination as a stand-alone screening tool for evaluation of the TL spine is inadequate. In this series, all the clinically significant missed fractures were diagnosed on computed tomography (CT) obtained for evaluation of the visceral torso. A combination of both clinical examination and CT screening based on mechanism will likely be required to ensure adequate sensitivity with an acceptable specificity for the diagnosis of clinically significant injuries of the TL spine. Further research is warranted, targeting the at-risk patient with a negative clinical examination, to determine what injury mechanisms warrant evaluation with a screening CT.