RESUMO
The recent adoption of endovascular and hybrid methods in the management of massive bleeding following trauma to the torso and junctional areas has been a major advance in trauma care. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is one tool to tackle immediate exsanguination in such cases. To take advantage of such methods, rapid femoral artery access is crucial. In rural hospitals a trauma surgeon, vascular surgeon and interventional radiologist may not be in the hospital during on-call hours. Furthermore, gaining femoral arterial access is an infrequent procedure for a trauma surgeon working outside major trauma centers. Therefore, it might be difficult to acquire and maintain the requisite skills. However, a consultant anesthesiologist is a member of the trauma team and always on call in our hospital. An experienced anesthesiologist is a valuable asset in ultrasound guided arterial punctures and in inserting intravascular introducer sheaths, as was the case in our patient. To our knowledge, anesthesiologists do not commonly participate in the actual placement of arterial introducer sheaths for REBOA catheters in trauma teams. We wish to bring to notice this hidden asset when a team that does not routinely include a vascular surgeon or an interventional radiologist is treating a seriously injured trauma patient. We report on a patient who had sustained a shrapnel injury to the groin with massive blood loss. To stop further bleeding and to stabilize hemodynamics, we used REBOA to gain proximal control of the bleeding. As a result, the patient avoided surgical retroperitoneal exposure and a dry surgical field was created. We conclude that REBOA may also have a place in rural hospitals, and that, if necessary, trauma team members may adopt novel roles in the treatment of hemorrhage.
RESUMO
The potential of human adipose stem cells (ASCs) for regenerative medicine has received recognition owing to their ease of isolation and their multilineage differentiation capacity. Additionally, low immunogenicity and immunosuppressive properties make them a relevant cell source when considering immunomodulation therapies and allogeneic stem cell treatments. In the current study, immunogenicity and immunosuppression of ASCs were determined through mixed lymphocyte reactions. The immunogenic response was analyzed after cell isolation and expansion in fetal bovine serum (FBS), human serum (HS)-supplemented medium, and xeno-free and serum-free (XF/SF) conditions. Additionally, the immunophenotype and the secretion of CXC chemokine ligand 8 (CXCL8), CXCL9, CXCL10, C-C chemokine ligand 2 (CCL2), CCL5, interleukin 2 (IL-2), IL-4, IL-6, IL-10, IL-17A, tumor necrosis factor-α, interferon-γ, transforming growth factor-ß1, indoleamine 2,3-deoxygenase, Galectin-1, and Galectin-3 were analyzed. The results showed that ASCs were weakly immunogenic when expanded in any of the three conditions. The significantly strongest suppression was observed with cells expanded in FBS conditions, whereas higher ASC numbers were required to display suppression in HS or XF/SF conditions. In addition, statistically significant differences in protein secretion were observed between direct versus indirect cocultures and between different culture conditions. The characteristic immunophenotype of ASCs was maintained in all conditions. However, in XF/SF conditions, a significantly lower expression of CD54 (intercellular adhesion molecule 1) and a higher expression of CD45 (lymphocyte common antigen) was observed at a low passage number. Although culture conditions have an effect on the immunogenicity, immunosuppression, and protein secretion profile of ASCs, our findings demonstrated that ASCs have low immunogenicity and promising immunosuppressive potential whether cultured in FBS, HS, or XF/SF conditions.
