Articles: trauma.
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Leukocyte-platelet aggregates (LPA) are associated with atherosclerosis, SIRS and sepsis. Severely injured patients often develop granulocytosis and present with coagulopathy with prolonged clotting times, impaired clot stability and fibrinolytic activation. Following major trauma, 'capture' of functional platelets on activated granulocytes might exacerbate trauma-induced coagulopathy. This study investigated whether the prevalence of activated granulocytes and/or platelets could impair the functional clot firmness in a viscoelastic test (ROTEM). ⋯ Our data obtained in an ex vivo assay indicate that the formation of LPA is associated with a diminished platelet count and a consecutive reduction in MCF.
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In the US, race and economic status have pervasive associations with mechanisms of injury, severity of injury, management, and outcomes of trauma. The goal of the current study was to examine these relationships on a large scale in the setting of pediatric spinal injury. ⋯ The epidemiology of pediatric spinal injury in the US cannot be understood apart from considerations of race and economic status.
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Venous thromboembolic events (VTE) occur in up to 20% of trauma patients and of these, pulmonary embolus is fatal in up to 50%. It is unknown whether fibrinolytic activation and consumption of precursors may subsequently render patients hypercoagulable. We hypothesised that an early hyperfibrinolytic state would lead to a propensity for developing VTE. ⋯ Patients developing VTE demonstrate early hyperfibrinolysis following injury. Hyperfibrinolysis depletes plasminogen and may induce a procoagulant state increasing susceptibility to VTE. Fibrinolytic profiling may improve risk stratification and enable targeted prophylaxis.
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Hemorrhagic shock (HS) is a common cause of death in severely injured patients and is associated with impairment of organ perfusion, systemic inflammatory response and multiple organ failure. The aim of the present study was to evaluate the effects of artesunate, the drug of choice for the treatment of falciparum malaria, on organ injury and dysfunction associated with HS in the rat. ⋯ A single-centre placebo-controlled randomized phase II clinical trial will be conducted at Barts Health NHS Trust (TOP-ART) in late 2015 to evaluate the effects of GMP-artesunate in patients with severe hemorrhage following trauma.
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Endogenous hydrogen sulfide (H2S) has been recently recognized as a molecule fundamentally involved in the regulation of mitochondrial bioenergetics. Therefore we aimed to compare maximum mitochondrial respiratory activity (JO2max) as well as the degree of coupling (L/E-ratio) in small homogenized liver and kidney tissue biopsies from wildtype (WT) and cystathionine γ-lyase (CSE)-KO mice who underwent an experimental thoracic trauma (TXT) or not (Sham). ⋯ We conclude that after a standardized thoracic trauma CSE deficiency only slightly influences mitochondrial respiration. The changes in the L/E-ratio probably result from compensatory mechanisms.