Plos One
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Trauma and hemorrhagic shock can lead to acute traumatic coagulopathy (ATC) that is not fully reversed by prehospital resuscitation as simulated with a limited volume of fresh whole blood (FWB) in a rat model. Tranexamic Acid (TXA) is used as an anti-fibrinolytic agent to reduce surgical bleeding if administered prior to or during surgery, and to improve survival in trauma if given early after trauma. It is not clear from the existing clinical literature whether TXA has the same mechanism of action in both settings. ⋯ In conclusion: Limited prehospital trauma resuscitation that includes FWB and TXA may not correct established systemic ATC, but rather may improve overall outcomes of resuscitation by attenuation of acute lung injury. By contrast, TXA given prior to trauma reduced levels of fibrinolysis at the site of tissue injury and circulatory d-dimer, and delayed development of coagulopathy independent of reduction of fibrinogen levels following trauma. These findings highlight the importance of early administration of TXA in trauma, and suggest that further optimization of dosing protocols in trauma to exploit TXA's various sites and modes of action may further improve patient outcomes.
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Randomized Controlled Trial Comparative Study
General strength and conditioning versus motor control with manual therapy for improving depressive symptoms in chronic low back pain: A randomised feasibility trial.
Exercise can be used as a treatment for depressive symptoms in the general population. However, little is known as to whether exercise has mental health benefits for adults experiencing chronic low back pain (CLBP). The aim of this study was to examine the feasibility of two intervention protocols commonly used in clinical practice for treating chronic low back pain, but with differing exercise dose, on depressive symptoms. ⋯ Reduction in depressive symptoms amongst adults with CLBP occurred with both treatment methods (motor control [low-dose exercise] and manual therapy; or general strength and conditioning [moderate-dose exercise]). Further interventions including a true control group are needed to draw conclusions as to the effectiveness of each of these treatment methods on depressive symptoms amongst adults with CLBP.
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Research in applied ecology provides scientific evidence to guide conservation policy and management. Applied ecology is becoming increasingly quantitative and model selection via information criteria has become a common statistical modeling approach. Unfortunately, parameters that contain little to no useful information are commonly presented and interpreted as important in applied ecology. ⋯ Given the prevalence of studies likely to have uninformative parameters or with insufficient information to assess parameter status (71.5%), I surmise that much of the policy recommendations based on applied ecology research may not be supported by the data analysis. I provide four warning signals and a decision tree to assist authors, reviewers, and editors to screen for uninformative parameters in studies applying model selection with information criteria. In the end, careful thinking at every step of the scientific process and greater reporting standards are required to detect uninformative parameters in studies adopting an information criteria approach.
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The paravertebral spread that occurs after erector spinae plane block may be volume-dependent. This cadaveric study was undertaken to compare the extent of paravertebral spread with erector spinae plane block using different dye volumes. After randomization, twelve erector spinae plane blocks were performed bilaterally with either 10 ml or 30 ml of dye at the level of T5 in seven unembalmed cadavers except for two cases of unexpected pleural puncture using the 10 ml injection. ⋯ In one 30 ml injection, sympathetic nerve involvement and epidural spread were observed at the level of the injection site. Although paravertebral spread following erector spinae plane block increased in a volume-dependent manner, this increase was variable and not pronounced. As the injectate volume increased for the erector spinae blocks, the injectate spread to the back muscles and fascial layers seemed to be predominantly increased compared with, the extent of paravertebral spread.
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The International Classification of Diseases (ICD) is the standard diagnostic tool for classifying and coding diseases and injuries. The Abbreviated Injury Scale (AIS) is the most widely used injury severity scoring system. Although manual coding is considered the gold standard, it is sometimes unavailable or impractical. There have been many prior attempts to develop programs for the automated conversion of ICD rubrics into AIS codes. ⋯ The process used in this study has proven to be a useful tool for selecting patients who meet the ISS>15 criterion for "major trauma". Further research is needed to improve the conversion process.