Decorin expression is decreased in human idiopathic fetal growth restriction.

Fetal growth restriction (FGR) is a clinically significant pregnancy disorder in which the fetus fails to achieve its full growth potential in utero. Most cases of FGR are idiopathic and are associated with placental thrombosis. Previous studies suggest that proteoglycans, such as decorin, that contain the glycosaminoglycan dermatan sulfate are the principal anticoagulants in the normal placenta. The present study investigated decorin expression in placentas from pregnancies complicated by idiopathic FGR (n = 26) and gestation-matched controls (n = 27). Real-time polymerase chain reaction demonstrated significantly reduced decorin mRNA expression in FGR compared with control (1.52 +/- 0.14 v. 2.21 +/- 0.22, respectively; P < 0.01). Immunoblotting revealed decreased decorin protein (40 kDa) expression in FGR compared with controls (420.8 +/- 39.0 v. 690.1 +/- 42.2, respectively; n = 12 in each group; P = 0.0007). Immunohistochemistry demonstrated the presence of immunoreactive decorin protein in the placental villous stroma surrounding the fetal capillaries and a significant decrease in decorin protein presence in FGR compared with control (1.75 +/- 0.66 v. 2.98 +/- 1.12, respectively; n = 6 in each group; P < 0.01, t-test). This is the first study to demonstrate reduced decorin in idiopathic FGR, indicating a potentially significant role for decorin in the aetiology of placental thrombosis in idiopathic FGR.

Decelerational thoracic injury.

BACKGROUND: Among the five major decelerational thoracic injuries [myocardial contusion (MC), traumatic aortic disruption (TAD), sternal fracture (SF), flail chest (FC), and tracheobronchial disruption (TBD)], coexisting injuries are seemingly rare. METHODS: To test this hypothesis, we reviewed the records of all patients, with final diagnosis (FDX) codes of these injuries, treated at our Level I trauma center for the 10 years preceding 1997. RESULTS: Among 142 patients, all victims of motor vehicle crashes, there were 38 MC, 36 TAD, 33 FC, 28 SF, and 7 TBD. There were six coexisting injuries (3.5%). Three patients with coexisting injury died in the operating room. All three had TAD; one of these three had TBD plus MC; one had additionally FC and MC and the third had FC in addition to the TAD. One patient with SF and probable MC died in the emergency room. Two patients with FC and a coexisting injury survived. One had MC, the other SF. CONCLUSION: We conclude that these decelerational thoracic injuries, with the exception of sternal fracture, are sufficiently life threatening by themselves to cause fatality. When combined, the threat to life is potentiated. Death occurs at the scene or shortly after arrival in the ER. The diagnosis of one may help exclude the diagnosis of each of the other four. The role of sternal fracture in this paradigm remains an enigma.

Trauma life support education: a didactic and caprine laboratory course for Nigerian physicians.

The purpose of this study was to introduce the principles of initial hospital assessment and treatment of injured patients, tailored to the facilities and resources available in Nigeria. A 3-day didactic and laboratory course was presented by four trauma surgeons. The didactic session stressed the initial assessment and treatment of injured patients. The caprine laboratory taught the performance of common resuscitation manoeuvres: cricothyroidotomy, tube thoracostomy, i.v. cut-down, diagnostic peritoneal lavage, etc. The mean pre-course test score was 49.3 per cent and the mean post-course test score was 69.5 per cent; 93.5 per cent of the 124 participants increased their test scores. This represents a significant increase in knowledge in Nigerian physicians. Academic medical centres are encouraged to make such courses available in developing countries.