Isr Med Assoc J
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Recent advances in pancreatic islet transplantation emphasize the potential of this approach for the long-term control of blood glucose levels as treatment of diabetes. To overcome the organ shortage for cell replacement therapy, efforts are being invested in generating new and abundant sources of insulin-producing cells from embryonic or adult stem cells. ⋯ The process of liver-to-pancreas developmental redirection is induced by ectopic expression of pancreatic transcription and differentiation factors. This approach may allow the diabetic patient to be the donor of his or her own therapeutic tissue, thus alleviating both the need for allotransplantations and the subsequent immune suppression.
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Although 40 years have passed since the advent of advanced cardiac life support, out-of-hospital cardiac arrest still carries an ultimate failure rate of 95%. This review reinforces the importance of public education, optimization of the local chain of survival, early bystander access and bystander basic life support, and early defibrillation. ⋯ The impact of automatic external defibrillators and new medications incorporated into ACLS algorithms is evaluated in the light of contemporary research. The persistent, discouraging, low functional survival rate (less than 5% of out-of-hospital cardiac arrest victims) mandates reassessment of current strategies and guidelines.
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The management of uncontrolled bleeding in trauma patients is difficult in the prehospital setting, especially when transfer time to a care facility is prolonged. The goal of treatment is to stabilize the patient until surgery can be performed. ⋯ The main problems are the logistics of handling the blood products as well as achieving the appropriate endpoint of resuscitation, while balancing the need to maintain blood pressure with the need to avoid deleterious coagulopathy. This work reviews current therapeutic modalities for prehospital management of uncontrolled bleeding trauma patients, namely low volume resuscitation, packed red blood cells, hemoglobin solutions, perfluorocarbons, hypertonic saline solutions, and recombinant activated factor VII.