Clin Lab
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The diversity of primary and secondary traumatic injuries specific for the critically ill polytrauma patient is complicating the therapeutic management in the absence of a strict assessment of the biological changes. Inflammation, redox imbalance, and immunosuppression can be quantified by various biochemical parameters; however, they do not fully respond to the current requirements. Another phenomenon responsible for worsening the clinical status and for the development of complications in such patients is oxidative stress. Its aggressiveness combined with biochemical and physiological imbalances leads to increased morbidity and mortality. To minimize the effects induced by free radicals, various substances are administered with high antioxidant capacity. However, the dosage optimization for each patient is difficult without strict monitoring of oxidative stress. In this paper we will summarize and present the pathophysiology of oxidative stress, as well as the specificity of miRNAs for a series of molecular changes at the cellular level. ⋯ Introducing miRNAs can revolutionize both monitoring and therapy modulation in these patients, adapting to the organic damage.
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Review Meta Analysis
Could Blood Neutrophil Gelatinase-Associated Lipocalin (NGAL) be a Diagnostic Marker for Acute Kidney Injury in Neonates? A Systemic Review and Meta-Analysis.
Blood neutrophil gelatinase-associated lipocalin (NGAL) has been shown to be helpful for acute kidney injury (AKI) in pediatric patients and adults. Whether this is true in neonates remains unclear. ⋯ Blood NGAL could be used as diagnostic marker for AKI in neonates.
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The transfusion efficacy of ATK, which contain fully functional platelets, is beyond all doubt. The equivalence of ATK and PTK has been subject of many studies. Some of those studies show the superiority of ATK's, while others do not, but there have been no studies that demonstrated a superiority of PTK's. ⋯ Through pathogen reduction, in parallel with platelet loss (Apoptosis), the function of the treated platelets is impaired. Alternatively, the cell destruction caused during this process could result in a release of platelet microRNA directly into the supernatant or in microvesicles. This reduction of microRNA will affect the storage of the platelets. (ABSTRACT TRUNCATED)
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Many children receive one or more units of red blood cell (RBC) preparations during their paediatric intensive care unit (PICU) admission depending on their underlying disease course. Physicians often justify RBC transfusions in critically ill children when anaemia is present because of the assumption that by increasing the haemoglobin level the delivery of oxygen (DO2) to peripheral tissues is improved so that ultimately the oxygen utilization (VO2) can be improved. ⋯ The TRIPICU study has clearly shown that it is safe to refrain from transfusing stable critically ill children unless their Hb has dropped below 7 g/dL (4.3 mmol/L) as increasing data emphasizes that the common practice of transfusing critically ill children is not free from causing harm as shown by increased morbidity and mortality. This narrative review summarizes the current literature and discusses possible pathophysiological mechanisms.
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Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion related morbidity and mortality. TRALI is suggested to be a "two hit" event. The "first hit" is the underlying condition of the patient which results in sequestration and priming of neutrophils in the pulmonary compartment. ⋯ Although it could be speculated that all of these factors may be involved in the onset of TRALI, only one pre-clinical study shows an association between the aged erythrocyte and the onset of TRALI. The suggested mechanism is a decrease in the chemokine scavenging function of the erythrocyte by reduction of the Duffy antigen expression resulting in an increase in lung injury. Further research is needed to elucidate possible mechanisms of onset of TRALI by aged blood products.