J Trauma
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The lack of knee flexion is an increasingly recognized complication of femoral and periarticular knee fractures. This is a significant challenge for both surgeon and patients. ⋯ Modified Thompson quadricepsplasty is a promising procedure with satisfactory results. It provides significantly results if it is performed earlier and in more severe extension contracture.
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Supporting its therapeutic application in sepsis, p38 mitogen-activated protein kinase (MAPK) inhibition decreases cardiopulmonary injury and lethality with lipopolysaccharide challenge. However, only one preclinical study has reported the survival effects of a p38 inhibitor (SB203580, 100 mg/kg) during infection. We therefore tested SB203580 in mice (n = 763) challenged with intratracheal Escherichia coli and treated with antibiotics and fluids. ⋯ Thus, SB203580 had divergent effects on cardiac and lung function in E. coli challenged mice. Furthermore, high dose worsened survival and low dose did not improve it. Altogether, these findings suggest that clearly defining the risks and benefits of p38 MAPK inhibition is important before such treatment is applied in patients with or at risk of serious infection.
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Severe injury can cause intestinal permeability through decreased expression of tight junction proteins, resulting in systemic inflammation. Activation of the parasympathetic nervous system after shock through vagal nerve stimulation is known to have potent anti-inflammatory effects; however, its effects on modulating intestinal barrier function are not fully understood. We postulated that vagal nerve stimulation improves intestinal barrier integrity after severe burn through an efferent signaling pathway, and is associated with improved expression and localization of the intestinal tight junction protein occludin. ⋯ Vagal nerve stimulation performed before injury improves intestinal barrier integrity after severe burn through an efferent signaling pathway and is associated with improved tight junction protein expression.
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Pulse contour-derived cardiac output for continuous hemodynamic monitoring is becoming popular in critical care. However, the data regarding its reliability during acute hemodynamic instability are inconsistent. This study was conducted to determine whether pulse contour-derived cardiac output truly reflects rapid hemodynamic changes. ⋯ Pulse contour-derived hemodynamic parameters do not accurately reflect rapid hemodynamic changes, and the trend may be misleading in piglets. Physicians are advised to interpret pulse contour-derived hemodynamic parameters with caution or to use invasive monitoring to guide treatment strategy therapy.
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Erythropoietin (EPO) can exert acute hemodynamic and anti-inflammatory effects in addition to erythropoiesis. We tested the hypothesis that EPO given at resuscitation with saline will improve capillary perfusion and tissue oxygenation in the gut using a hemorrhagic shock model. ⋯ Our results suggest that the addition of rHuEPO at the time of saline resuscitation may have beneficial effects in hemorrhagic shock by improving tissue perfusion and decreasing dysoxia in the gut.