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1.
J Agric Food Chem ; 68(6): 1621-1633, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-31967468

RESUMO

Collagen peptides can promote wound healing and are closely related to microbiome colonization. We investigated the relationship among collagen peptides, wound healing, and wound microflora colonization by administering the murine wound model with Salmo salar skin collagen peptides (Ss-SCPs) and Tilapia nilotica skin collagen peptides (Tn-SCPs). We analyzed the vascular endothelial growth factor (VEGF), fibroblast growth factors (ß-FGF), pattern recognition receptor (NOD2), antimicrobial peptides (ß-defence14, BD14), proinflammatory (TNF-α, IL-6, and IL-8) and anti-inflammatory (IL-10) cytokines, macrophages, neutrophil infiltration levels, and microbial communities in the rat wound. The healing rates of the Ss-SCP- and Tn-SCP-treated groups were significantly accelerated, associated with decreased TNF-α, IL-6, and IL-8 and upregulated BD14, NOD2, IL-10, VEGF, and ß-FGF. Accelerated healing in the collagen peptide group shows that the wound microflora such as Leuconostoc, Enterococcus, and Bacillus have a positive effect on wound healing (P < 0.01). Other microbiome species such as Stenotrophomonas, Bradyrhizobium, Sphingomonas, and Phyllobacterium had a negative influence and decreased colonization (P < 0.01). Altogether, these studies show that collagen peptide could upregulate wound NOD2 and BD14, which were implicated in microflora colonization regulation in the wound tissue and promoted wound healing by controlling the inflammatory reaction and increasing wound angiogenesis and collagen deposition.


Assuntos
Colágeno/química , Proteínas de Peixes/química , Microbiota/efeitos dos fármacos , Proteína Adaptadora de Sinalização NOD2/genética , Peptídeos/administração & dosagem , Pele/química , Ferimentos e Lesões/fisiopatologia , beta-Defensinas/genética , Administração Cutânea , Animais , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/genética , Bactérias/isolamento & purificação , Ciclídeos , Fatores de Crescimento de Fibroblastos/genética , Fatores de Crescimento de Fibroblastos/imunologia , Humanos , Interleucina-10/genética , Interleucina-10/imunologia , Masculino , Camundongos , Proteína Adaptadora de Sinalização NOD2/imunologia , Peptídeos/química , Ratos , Ratos Sprague-Dawley , Salmo salar , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/imunologia , Fator A de Crescimento do Endotélio Vascular/genética , Fator A de Crescimento do Endotélio Vascular/imunologia , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/tratamento farmacológico , Ferimentos e Lesões/imunologia , Ferimentos e Lesões/microbiologia , beta-Defensinas/imunologia
3.
BMC Complement Altern Med ; 19(1): 290, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666058

RESUMO

BACKGROUND: Nigella sativa or commonly known as black seed or black cumin is one of the most ubiquitous complementary medicine. Epithelial to mesenchymal transition (EMT) of type 2 is defined by the balance between wound healing and tissue fibrosis, which is dependent to the state of inflammation. This systematic review is conducted to provide an overview regarding the reported effect of Nigella sativa and its bioactive compound on the type 2 EMT. METHODS: A search was done in EBSCOHOST, OVID and SCOPUS database to obtain potentially relevant articles that were published between 1823 and August 2019. This review includes studies that focus on the effect of Nigella sativa and its bioactive compound on the events related to type 2 EMT. RESULTS: A total of 1393 research articles were found to be potentially related to the effect of Nigella sativa and its bioactive compound, thymoquinone on Type 2 EMT. After screening was done, 22 research articles met inclusion criteria and were included in this review. Majority of the studies, reported better wound healing rate or significant prevention of tissue inflammation and organ fibrosis following Nigella sativa or thymoquinone treatments. In terms of wound healing, studies included reported progression of EMT related pathological changes after treatment with Nigella sativa or thymoquinone. Alternatively, in terms of fibrosis and inflammation, studies included reported reversal of pathological changes related to EMT after treatment with Nigella sativa or thymoquinone. CONCLUSION: Through this review, Nigella sativa and thymoquinone have been associated with events in Type 2 EMT. They have been shown to promote wound healing, attenuate tissue inflammation, and prevent organ fibrosis via regulation of the EMT process.


Assuntos
Transição Epitelial-Mesenquimal/efeitos dos fármacos , Nigella sativa/química , Extratos Vegetais/química , Extratos Vegetais/uso terapêutico , Ferimentos e Lesões/tratamento farmacológico , Animais , Benzoquinonas/análise , Benzoquinonas/uso terapêutico , Humanos , Fitoterapia , Resultado do Tratamento , Ferimentos e Lesões/fisiopatologia
4.
Nat Neurosci ; 22(11): 1782-1792, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31636451

RESUMO

Microglia are the brain's resident innate immune cells and also have a role in synaptic plasticity. Microglial processes continuously survey the brain parenchyma, interact with synaptic elements and maintain tissue homeostasis. However, the mechanisms that control surveillance and its role in synaptic plasticity are poorly understood. Microglial dynamics in vivo have been primarily studied in anesthetized animals. Here we report that microglial surveillance and injury response are reduced in awake mice as compared to anesthetized mice, suggesting that arousal state modulates microglial function. Pharmacologic stimulation of ß2-adrenergic receptors recapitulated these observations and disrupted experience-dependent plasticity, and these effects required the presence of ß2-adrenergic receptors in microglia. These results indicate that microglial roles in surveillance and synaptic plasticity in the mouse brain are modulated by noradrenergic tone fluctuations between arousal states and emphasize the need to understand the effect of disruptions of adrenergic signaling in neurodevelopment and neuropathology.


Assuntos
Microglia/fisiologia , Plasticidade Neuronal/fisiologia , Norepinefrina/fisiologia , Córtex Visual/fisiologia , Animais , Benzilaminas/farmacologia , Receptor 1 de Quimiocina CX3C/genética , Movimento Celular/efeitos dos fármacos , Movimento Celular/fisiologia , Ritmo Circadiano/fisiologia , Clembuterol/farmacologia , Dexmedetomidina/farmacologia , Dominância Ocular , Feminino , Fentanila/farmacologia , Locus Cerúleo/efeitos dos fármacos , Masculino , Camundongos , Camundongos Transgênicos , Microglia/citologia , Microglia/efeitos dos fármacos , Nadolol/farmacologia , Plasticidade Neuronal/efeitos dos fármacos , Neurônios/metabolismo , Neurônios/fisiologia , Norepinefrina/metabolismo , Propanolaminas/farmacologia , Restrição Física/fisiologia , Terbutalina/farmacologia , Vigília , Ferimentos e Lesões/fisiopatologia
5.
Am Surg ; 85(9): 1010-1012, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638515

RESUMO

Many trauma patients present to nontrauma centers with emergency conditions. The Emergency Medical Treatment and Active Labor Act dictates that nontrauma centers attempt stabilization and provide appropriate transfer. Our goal was to determine whether there was a survival benefit in transferring hypotensive patients. The Tampa General Hospital trauma registry database was queried for adult trauma transfers from January 2012 to April 2018 including the first recorded systolic blood pressure (SBP) and other pertinent data. A manual chart review in hypotensive (SBP < 90) patients determined blood pressure at the time of transfer. Of the 3038 patients, 40 patients were hypotensive on arrival, with 40% (16) mortality. Eight of nine (88%) patients with SBP <70 on arrival, 3 of 11 (27%) with SBP 70 to 79, and 5 of 20 (25%) with SBP 80 to 89 died. The only survivor in the <70 group was normotensive at transport. Patients in these groups who were hypotensive at the time of transport died (4/4, 100%). Our data show no benefit in transferring patients with refractory hypotension at the time of transport; although the numbers are small, an SBP <70 should be considered prohibitive to transfer.


Assuntos
Hipotensão/etiologia , Hipotensão/terapia , Transferência de Pacientes , Centros de Traumatologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia , Adulto , Florida , Humanos , Sistema de Registros , Estudos Retrospectivos , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/fisiopatologia
6.
Food Funct ; 10(10): 6267-6275, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31584060

RESUMO

A polyphenolic-rich fraction (CG50) was obtained from the methanol extract of Coccinia grandis leaves by chromatographic fractionation over a Diaion column using 50% aqueous methanol. LC-ESI-MS/MS analysis of CG50 showed the presence of six flavonoids, namely quercetin-hexoside deoxyhexoside (rutin), quercetin-hexoside deoxyhexoside (quercetin-3-O-neohesperidoside), kaempferol-hexoside deoxyhexoside (kaempferol-3-O-rutinoside), kaempferol-hexoside deoxyhexoside (kaempferol-3-O-neohesperidoside), kaempferol-3-O-glucoside, and kaempferol-hexoside in addition to the presence of two secoiridoids which are oleuropein and ligstroside. CG50 hydrogel showed a pronounced inhibition of the bacterial growth in wounds infected by Bacillus cereus in rats comparable to those treated with hydrogel base only showing 85.08 and 16.50% inhibition for the bacterial growth for the CG50 hydrogel and hydrogel base, respectively. The antimicrobial activity of CG50 hydrogel was close to that of fucidin during all days of treatment. Rats treated with CG50 hydrogel showed remarkable healing ability of the wound compared to other groups and approaching that of fucidin. This was clearly manifested by the clear formation of scars with obvious reduction in the wound size together with the appearance and re-growth of hair. This was further confirmed by the histopathological study of skin tissues as well as by the evaluation of the percentages of collagen fiber deposition. CG50 hydrogel showed 18.71% collagen fiber deposition comparable to the untreated group that showed 6.84% collagen fiber deposition and approaches that of the fucidin group. It was concluded that Coccinia grandis could be used as a natural wound healing agent that further consolidated its traditional use as a wound dressing.


Assuntos
Antibacterianos/administração & dosagem , Cucurbitaceae/química , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Extratos Vegetais/administração & dosagem , Polifenóis/administração & dosagem , Ferimentos e Lesões/tratamento farmacológico , Animais , Antibacterianos/química , Antibacterianos/metabolismo , Bacillus cereus/efeitos dos fármacos , Bacillus cereus/fisiologia , Cromatografia Líquida de Alta Pressão , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/fisiopatologia , Humanos , Masculino , Extratos Vegetais/química , Folhas de Planta/química , Polifenóis/química , Polifenóis/metabolismo , Ratos , Espectrometria de Massas em Tandem , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/fisiopatologia
7.
BMC Complement Altern Med ; 19(1): 254, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31511001

RESUMO

BACKGROUND: Fumaria species (Fumariacea) has traditionally been used in wound healing in Iranian folk medicine. However, with the discovery of newer agents, its use has faded off into total obscurity. This study explored the wound healing potential of a gel containing 10% Fumaria vaillantii Loisel through topical application of total extract in a model of excisional as well as incisional wound healing in albino Wistar rats. METHODS: Rats were anesthetized, and excisional skin wound was established using a sterilized surgical scissors. The animals were then treated with 10% F.vaillantii topical gel formulation along with the gel base. The treatments were administered once a day after the injury for 21 days. For topical treatment, the hydrogel was formulated and evaluated for chemical and physical characteristics. Histopathological analysis with hematoxylin and eosin (H&E) was used for microscopic examination of the skin tissues on 21-day-old sections of excision wound. To verify collagen formation, hydroxyproline determination was performed 21 days post wound healing. Breaking strength was determined in a 10-day-old incision wound by the uniaxial tensile test. RESULTS: Topical administration of F.vaillantii gel formulation significantly enhanced skin wound closure on the 6th post-wounding day compared to both gel base and the negative control, indicating an accelerated wound healing process, while a significant difference was observed on 10th and 14th post -wound days in F.vaillantii treatment compared to the negative control groups. Gel formulation prepared with a 10% F. vaillantii extract exhibited a response in terms of wound epithelialization, angiogenesis and number of hair follicles at wound area better than the gel base on the 21st post-wound day. Application of gel base produced further advantages by increasing hydroxyproline content and collagen fiber thickness. Our results on incision wound model were supported by histopathological data indicating the role of gel base in the enhancement of breaking strength. CONCLUSION: Traditional use of Fumaria species in the skin diseases was justified in this study by revealing the increase in wound healing activity after hydrogel containing F. vaillantii total extract administration.


Assuntos
Fumaria/química , Extratos Vegetais/administração & dosagem , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/tratamento farmacológico , Administração Tópica , Animais , Humanos , Hidrogéis/administração & dosagem , Hidrogéis/química , Masculino , Extratos Vegetais/química , Ratos , Ratos Wistar , Pele/efeitos dos fármacos , Pele/lesões , Pele/fisiopatologia , Ferimentos e Lesões/fisiopatologia
8.
Chin J Traumatol ; 22(5): 296-299, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31481277

RESUMO

The incidence of chronic wounds has been increasing over the past 20 years. However, the standardized diagnosis and treatment practice of chronic refractory wounds have not been established. In addition, the properties of the wound are characterized by morphology and thus correct description of the wound in medical history collection plays a vital role, which directly affects the definitive diagnosis. To develop more accurate format of clinical history record which can correctly reflect a patient's course and treatment progress, and to standardize the medical history record of chronic refractory wounds, at the national or regional level, we designed the WoundCareLog APP. It acts as a recording and communication tool for wound healing specialists at all levels of medical institutions in China. The WoundCareLog APP is fully compatible to meet the criteria and requirements of conventional medical records by embedding 9 modules. In addition, the demands for morphological description of wounds in wound healing diagnosis and treatment have been fulfilled by enroll of digital imaging technology to overcome the inadequacies of traditional medical history records.


Assuntos
Aplicativos Móveis , Cicatrização , Ferimentos e Lesões/diagnóstico , China , Doença Crônica , Humanos , Ferimentos e Lesões/patologia , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/terapia
9.
BMC Complement Altern Med ; 19(1): 213, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412845

RESUMO

BACKGROUND: Various extracts of Centella asiatica (Apiaceae) and its active constituent, asiaticoside, have been reported to possess wound healing property when assessed using various in vivo and in vitro models. In an attempt to develop a formulation with accelerated wound healing effect, the present study was performed to examine in vivo efficacy of asiaticoside-rich hydrogel formulation in rabbits. METHODS: Asiaticoside-rich fraction was prepared from C. asiatica aerial part and then incorporated into polyvinyl alcohol/polyethylene glycol (PVA/PEG) hydrogel. The hydrogel was subjected to wound healing investigation using the in vivo incision model. RESULTS: The results obtained demonstrated that: i) the hydrogel formulation did not cause any signs of irritation on the rabbits' skin and; ii) enhanced wound healing 15% faster than the commercial cream and > 40% faster than the untreated wounds. The skin healing process was seen in all wounds marked by formation of a thick epithelial layer, keratin, and moderate formation of granulation tissues, fibroblasts and collagen with no fibrinoid necrosis detected. CONCLUSION: The asiaticoside-rich hydrogel developed using the freeze-thaw method was effective in accelerating wound healing in rabbits.


Assuntos
Centella/química , Triterpenos/administração & dosagem , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/tratamento farmacológico , Animais , Humanos , Hidrogéis/administração & dosagem , Hidrogéis/química , Masculino , Coelhos , Triterpenos/química , Ferimentos e Lesões/fisiopatologia
10.
Medicina (Kaunas) ; 55(9)2019 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-31450705

RESUMO

Background: Cycling is a popular source of recreation and physical activity for children and adults. With regard to the total number of sports injuries, cycling has the highest absolute number of injuries per year in the United States population. Cycling injuries can be classified into bicycle contact, traumatic, or overuse injuries. Aim of this study: The aims of this case report are to report a rare clinical complication of glenohumeral joint anterior dislocation that resulted in a patient experiencing continuous GHJ dislocations secondary to involuntary violent muscular spasms and emphasize the role of the physical therapist's differential diagnosis and clinical decision-making process in a patient following direct access referral. Case presentation: A professional 23-year-old cyclist presented to a physical therapist with spontaneous multidirectional dislocations to the right shoulder after the recurrence of trauma occurred during a recent cycling race. The dislocations do not occur at night, but occur during the day, randomly, and mostly associated with changes in the patient's psychological conditions. Directly from the clinical history, the physical therapist identified a neuro-physiological orange flag as well as an orthopedic red flag and, therefore, decided it was appropriate to refer the patient to a neurologist. It was determined by the physical therapist to be a priority to focus on the patient's neurologic status and then to evaluate the orthopedic problem. The neurological examination revealed a condition of spontaneous multidirectional dislocation associated with recurrent antero-posterior pain spasms of the shoulder joint. The neurologist prescribed medication. Following the second cycle of medication assumption, the patient was able to continue physiotherapy treatment and was referred to the orthopedic specialist to proceed with shoulder stabilization surgery. Discussion and conclusion: Currently, the diagnosis of this unusual clinical condition is still unclear. It is a shared opinion of the authors that the trauma during the past bicycle race awakened an underlying psychological problem of the patient that resulted in a clinical condition of weakness of all the structures of the shoulder, such that these spasms could result in multiple multidirectional dislocations.


Assuntos
Ciclismo/lesões , Luxação do Ombro/diagnóstico , Acidentes por Quedas , Atletas , Ciclismo/estatística & dados numéricos , Humanos , Itália , Imagem por Ressonância Magnética/métodos , Masculino , Luxação do Ombro/complicações , Luxação do Ombro/diagnóstico por imagem , Espasmo/etiologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/fisiopatologia , Adulto Jovem
11.
J Surg Res ; 244: 212-217, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299438

RESUMO

BACKGROUND: The population of Latin America is aging. Research from high-income countries demonstrates geriatric trauma is associated with higher morbidity and mortality. Very little research exists on geriatric patient (GP) injury prevalence in low-resource settings, like Bolivia. METHODS: Data were collected prospectively for 34 mo in the emergency departments of six trauma registry hospitals in Santa Cruz, Bolivia. Data were analyzed with Stata v14. Comparisons were made between GPs, defined as age greater than 65 y, and younger patients (YPs), with ages 18-64 y. RESULTS: Of n = 8796 trauma registry patients, 10.1% (n = 797) were aged 65 y or above, and n = 4989 (63.1%) were aged 18-64 y. The majority of GPs suffered falls (n = 543, 69.6%) versus 30.9% (n = 1541) of YPs (P < 0.001). Frequently, GPs had isolated injuries of the pelvis/hip (15.9% versus 1.4% YP, P < 0.0001) or upper extremity (15.8% versus 18.5% YP, P = 0.07), while YPs had a higher incidence of multiple injuries (YP 14.8% versus GP 8.4%, P < 0.001). While the majority of patients were discharged home (GP 43.0% versus YP 48.1%, P = 0.008), GPs were more likely to be admitted to the hospital (32.3% versus 22.3%, P < 0.001). CONCLUSIONS: As life expectancy improves, the incidence of geriatric trauma will continue to increase. Understanding the characteristics associated with trauma in GP can allow for effective prevention methods, resource distribution, and discharge planning.


Assuntos
Envelhecimento/fisiologia , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Bolívia/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/fisiopatologia , Adulto Jovem
12.
Foot Ankle Int ; 40(11): 1282-1287, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31319712

RESUMO

BACKGROUND: The functional capacity evaluation (FCE) is used to determine physical ability after treatment of a workplace-related injury. This evaluation is a determinant in the administration of benefits and the decision to return to work (RTW). The purpose of this study was to characterize FCE results and ability to RTW after treatment for workplace-related orthopedic injuries to the foot or ankle. METHODS: A retrospective medical record review from the practices of 4 orthopedic foot and ankle surgeons was conducted. Inclusion criteria were a workplace-related injury to the foot or ankle, at least 2 years of follow-up, and an associated FCE. The FCE report and clinic notes were used to determine the patient's preinjury job requirement, postinjury FCE-determined ability, specific FCE- or physician-imposed work restrictions, and clearance to RTW. A total of 188 patients met inclusion criteria. RESULTS: In total, 74.4% of patients had FCE-determined work abilities at or above their preinjury job requirements, and 63.3% of patients were cleared to RTW. The mean time from injury to FCE was 1.9 ± 1.5 years, and the mean time to clearance for RTW was 2.0 ± 1.3 years. A less strenuous preinjury job requirement was positively associated with both the FCE-determined ability meeting the preinjury job requirement (P < .001) and clearance to RTW (P = .034). CONCLUSION: Two in 3 patients were cleared to RTW following workplace-related injuries to the foot or ankle culminating in an FCE. However, it took a mean of 2 years to achieve this clearance. Patients with more strenuous jobs were less likely to be able to RTW after injury. LEVEL OF EVIDENCE: Level III, retrospective comparative study.


Assuntos
Traumatismos do Tornozelo/fisiopatologia , Traumatismos do Pé/fisiopatologia , Ferimentos e Lesões/fisiopatologia , Avaliação da Deficiência , Humanos , Médicos , Estudos Retrospectivos , Avaliação da Capacidade de Trabalho , Ferimentos e Lesões/prevenção & controle
13.
J Trauma Acute Care Surg ; 87(1): 234-239, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31260428

RESUMO

BACKGROUND: Volume replacement strategies and resuscitation endpoints of therapy in the critical ill or injured patient continues to be a heavily debated topic despite decades of research and the ever evolving technologies that provide for alternate methods of monitoring. Hemodynamic transesophageal echocardiography (hTEE), refined for the use in the intensive care unit (ICU), allows for direct visualization of cardiac filling and function, enabling real-time guidance in the resuscitation of critically ill patients. The disposable, 17F hTEE probe can remain indwelling for up to 72 hours, providing continuous, unobstructed assessments of cardiac activity via the transgastric short axis, midesophageal four chamber, and superior vena cava views. With such, preload and contractility, ventricular size and function, and volume responsiveness can be accurately evaluated and trended for change over time. Hemodynamic transesophageal echocardiography as a monitoring modality is becoming more pervasive in ICUs on a worldwide scale, allowing for real-time visualization of resuscitation and its therapeutic effects, a better understanding of resuscitation effects on individual patients, a more rapid conclusion to patient's resuscitation needs and provides the physician more confidence and patience in guiding complex volume resuscitations. RESULTS: This presentation will focus on discussing practical applications of the hTEE system and its benefits in critical care management. We will review four patients at our facility admitted to the ICU due to hemodynamic instability of varying etiologies that required volume resuscitation. With the videos, we will demonstrate how hTEE can guide patient therapy, often counter-intuitively, in the critically ill using the three basic cardiac views. Specific scenarios and hTEE videos include: (1) volume resuscitation in Acute Respiratory Distress Syndrome (ARDS), (2) volume resuscitation guided by hTEE, (3) underresuscitation in a "routine" trauma case, and (4) deescalation of therapy by weaning of high-dose vasopressors using hTEE monitoring. CONCLUSION: Hemodynamic transesophageal echocardiography is an excellent hemodynamic monitoring modality for the intensivist and has many practical applications in the management of the critical ill or injured patients. Hemodynamic transesophageal echocardiography has demonstrated that patient's resuscitation needs are often underestimated and that a more tailored approach to volume delivery is achievable, a particular benefit in the older and more comorbid patient. Future applications of hTEE include CRRT volume management, organ donor hemodynamic optimization, and postresuscitation monitoring in trauma patient requiring massive transfusion protocol. These videos demonstrate examples of the benefits of real-time cardiac monitoring, which allowed for guided resuscitation and improved patient outcomes. LEVEL OF EVIDENCE: Procedures and techniques, level IV.


Assuntos
Ecocardiografia Transesofagiana/métodos , Hemodinâmica , Ressuscitação/métodos , Adulto , Idoso , Coração/diagnóstico por imagem , Coração/fisiopatologia , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Síndrome do Desconforto Respiratório do Adulto/terapia , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/terapia , Adulto Jovem
14.
Biomed Res Int ; 2019: 5936345, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31321238

RESUMO

Background: The impact of time (the golden period of trauma) on the outcome of severely injured patients has been well known for a long time. While the duration of the prehospital phase has changed only slightly (average time: ~66 min) since the TraumaRegister DGU® (TR-DGU®) was implemented, mortality rates have decreased within the last 20 years. This study analyzed the influence of prehospital time on the outcome of trauma patients in a matched-triplet analysis. Material and Methods: A total of 93,024 patients from the TraumaRegister DGU® were selected based on the following inclusion criteria: ISS ≥ 16, primary admission, age ≥ 16 years, and data were available for the following variables: prehospital intubation, blood pressure, mode of transportation, and age. The patients were assigned to one of three groups: group 1: 10-50 min (short emergency treatment time); group 2: 51-75 min (intermediate emergency treatment time); group 3: >75 min (long emergency treatment time). A matched-triplet analysis was conducted; matching was based on the following criteria: intubation at the accident site, rescue resources, Abbreviated Injury Scale (AIS) of the body regions, systolic blood pressure, year of the accident, and age. Results: A total of 4,617 patients per group could be matched. The number of patients with a GCS score ≤8 was significantly higher in the first group (group 1: 36.6%, group 2: 33.5%, group 3: 30.3%; p < 0.001). Moreover, the number of patients who had to be resuscitated during the prehospital phase and/or upon arrival at the hospital was higher in group 1 (p = 0.010); these patients also had a significantly higher mortality (group 1: 20.4%, group 2: 18.1%, group 3: 15.9%; p ≤ 0.001). The number of measures performed during the prehospital phase (e.g., chest tube insertion) increased with treatment time. Conclusions: The results suggest that survival after severe trauma is not only a matter of short rescue time but more a matter of well-used rescue time including performance of vital measures already in the prehospital setting. This also includes that rescue teams identify the severity of injuries more rapidly in the most-severely injured patients in critical condition than in less-severely injured patients and plan their interventions accordingly.


Assuntos
Traumatismo Múltiplo/epidemiologia , Fatores de Tempo , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Idoso , Serviços Médicos de Emergência , Tratamento de Emergência , Feminino , Alemanha/epidemiologia , Humanos , Escala de Gravidade do Ferimento , Intubação , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/fisiopatologia , Traumatismo Múltiplo/terapia , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/terapia , Adulto Jovem
15.
J Surg Res ; 244: 477-483, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31330291

RESUMO

BACKGROUND: Augmented renal clearance (ARC; i.e., creatinine clearance [CLCr] ≥ 130 mL/min) has an incidence of 14%-80% in critically ill patients and has been associated with therapy failures for renally cleared drugs. However, the clinical implications of ARC are poorly defined. We hypothesize that modifiable risk factors that contribute to ARC can be identified in severely injured trauma patients and that these risk factors influence clinical outcome. METHODS: In 207 trauma intensive care unit patients, 24-h CLCr was correlated with clinical estimates of glomerular filtration rate (by Cockroft-Gault, modification of diet in renal disease, or chronic kidney disease epidemiology), and clinical outcomes (infection, venous thromboembolism [VTE], length of stay, and mortality). RESULTS: The population was 45 ± 20 y, 68% male, 77% blunt injury with injury severity score of 24 (17-30). Admission serum creatinine was 1.02 ± 0.35 mg/dL, CLCr was 154 ± 77 mL/min, VTE incidence was 15%, ARC incidence was 57%, and mortality was 11%. Clinical estimates of glomerular filtration rate by Cockroft-Gault, modification of diet in renal disease, chronic kidney disease epidemiology underestimated actual CLCr by 20%, 22%, or 15% (all P < 0.01). CLCr was higher in males and those who survived, and lower in those with hypertension, diabetes, positive cultures, receiving transfusions, or pressors (all P < 0.05). On multivariate analysis, male gender (odds ratio [OR] 2.9 [1.4-6.1]), age (OR 0.97 [0.95-0.99]), and packed red blood cells transfusion (OR 0.31 [0.15-0.66]) were the only independent predictors of ARC. CONCLUSIONS: ARC occurs in more than half of all high-risk trauma intensive care unit patients and is underestimated by standard clinical equations. ARC was not associated with increased incidence of VTE or infection but rather is associated with younger healthier males and reduced mortality. ARC seems to be a beneficial compensatory response to trauma.


Assuntos
Taxa de Filtração Glomerular , Rim/fisiopatologia , Ferimentos e Lesões/complicações , Adulto , Idoso , Creatinina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia , Ferimentos e Lesões/fisiopatologia
16.
Hosp Pract (1995) ; 47(3): 143-148, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31343374

RESUMO

Objective: To determine the mean number of procedural painful episodes per patient, and to retrieve information regarding diagnosis, therapeutic procedures and analgesic management, in patients visiting Emergency Departments (EDs) for minor trauma. Methods: This observational, non-interventional, multicenter study in adult patients was performed in 35 French EDs. All patients entering the EDs for minor trauma on a specified day between noon and 10 pm were registered; consenting patients were included in the study. Pain intensity was assessed using a verbal Numerical Rating Scale from 0 (no pain) to 10 (worst possible pain). An episode was described as painful if the difference in pain intensity between pain just before the procedure and maximal pain during the procedure was ≥2. Two independent nurses recorded data on 1 day in each center. Results: Overall, 909 patients were registered, 422 were included in the study, and complete data for 409 patients (1899 procedures) were available for analysis. The mean number of painful episodes per patient was 1.0 ± 1.3. Fifty-one percent of patients reported at least one painful procedure episode. Twenty-one percent of procedures were considered painful. Clinical examination was the procedure most often reported as painful. No preventive or curative analgesic treatment was reported in 95.1% of procedures. Conclusions: There is a need for improvement in routine pain assessment and, therefore, procedural pain management for ED patients. Specific protocols should be developed for procedural pain management, and teams should be trained especially for procedures usually not considered painful.


Assuntos
Analgésicos/uso terapêutico , Serviço Hospitalar de Emergência , Manejo da Dor , Ferimentos e Lesões/tratamento farmacológico , Adulto , Feminino , França , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Ferimentos e Lesões/fisiopatologia , Adulto Jovem
17.
Sensors (Basel) ; 19(15)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31357572

RESUMO

This study aims to characterize traumatic spinal cord injury (TSCI) neurophysiologically using an intramuscular fine-wire electromyography (EMG) electrode pair. EMG data were collected from an agonist-antagonist pair of tail muscles of Macaca fasicularis, pre- and post-lesion, and for a treatment and control group. The EMG signals were decomposed into multi-resolution subsets using wavelet transforms (WT), then the relative power (RP) was calculated for each individual reconstructed EMG sub-band. Linear mixed models were developed to test three hypotheses: (i) asymmetrical volitional activity of left and right side tail muscles (ii) the effect of the experimental TSCI on the frequency content of the EMG signal, (iii) and the effect of an experimental treatment. The results from the electrode pair data suggested that there is asymmetry in the EMG response of the left and right side muscles (p-value < 0.001). This is consistent with the construct of limb dominance. The results also suggest that the lesion resulted in clear changes in the EMG frequency distribution in the post-lesion period with a significant increment in the low-frequency sub-bands (D4, D6, and A6) of the left and right side, also a significant reduction in the high-frequency sub-bands (D1 and D2) of the right side (p-value < 0.001). The preliminary results suggest that using the RP of the EMG data, the fine-wire intramuscular EMG electrode pair are a suitable method of monitoring and measuring treatment effects of experimental treatments for spinal cord injury (SCI).


Assuntos
Músculo Esquelético/diagnóstico por imagem , Traumatismos da Medula Espinal/diagnóstico por imagem , Ferimentos e Lesões/diagnóstico por imagem , Animais , Modelos Animais de Doenças , Eletrodos Implantados , Eletromiografia , Humanos , Macaca fascicularis , Músculo Esquelético/fisiologia , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/fisiopatologia , Cauda/fisiologia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/fisiopatologia
18.
Sensors (Basel) ; 19(15)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31357650

RESUMO

Wearable robotic braces have the potential to improve rehabilitative therapies for patients suffering from musculoskeletal (MSK) conditions. Ideally, a quantitative assessment of health would be incorporated into rehabilitative devices to monitor patient recovery. The purpose of this work is to develop a model to distinguish between the healthy and injured arms of elbow trauma patients based on electromyography (EMG) data. Surface EMG recordings were collected from the healthy and injured limbs of 30 elbow trauma patients while performing 10 upper-limb motions. Forty-two features and five feature sets were extracted from the data. Feature selection was performed to improve the class separation and to reduce the computational complexity of the feature sets. The following classifiers were tested: linear discriminant analysis (LDA), support vector machine (SVM), and random forest (RF). The classifiers were used to distinguish between two levels of health: healthy and injured (50% baseline accuracy rate). Maximum fractal length (MFL), myopulse percentage rate (MYOP), power spectrum ratio (PSR) and spike shape analysis features were identified as the best features for classifying elbow muscle health. A majority vote of the LDA classification models provided a cross-validation accuracy of 82.1%. The work described in this paper indicates that it is possible to discern between healthy and injured limbs of patients with MSK elbow injuries. Further assessment and optimization could improve the consistency and accuracy of the classification models. This work is the first of its kind to identify EMG metrics for muscle health assessment by wearable rehabilitative devices.


Assuntos
Cotovelo/diagnóstico por imagem , Eletromiografia , Músculo Esquelético/diagnóstico por imagem , Ferimentos e Lesões/diagnóstico por imagem , Adulto , Algoritmos , Análise Discriminante , Cotovelo/lesões , Cotovelo/fisiopatologia , Feminino , Humanos , Masculino , Músculo Esquelético/lesões , Músculo Esquelético/fisiopatologia , Reconhecimento Automatizado de Padrão/métodos , Processamento de Sinais Assistido por Computador , Máquina de Vetores de Suporte , Dispositivos Eletrônicos Vestíveis , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/reabilitação
19.
Medicina (Kaunas) ; 55(6)2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31185662

RESUMO

Background: Trauma-induced aortic injuries continue to be an important factor in morbimortality in patients with blunt trauma. Objectives: To determine the characteristics of aortic lesions in patients with closed thoracic trauma and associated thoracic injuries. Methods: Multicenter cohort study conducted during the years 1994 to 2014 in the radiology service in the University Hospital Complex of A Coruña. Patients >15 years with closed thoracic trauma were included. Sociodemographic and clinical variables were studied in order to determine the lesion cause, location, and degree. Results: We analyzed 232 patients with a mean age of 46.9 ± 18.7 years, consisting of 81.4% males. The most frequent location was at the level of the isthmus (55.2%). The most frequent causes of injury were traffic accidents followed by falls. Patients with aortic injury had more esophageal, airway, and cardiopericardial lesions. More than 85% of the patients had lung parenchyma and/or chest wall injury, which was more prevalent among those who did not have an aortic lesion. Conclusions: Patients with trauma due to traffic accidents or being run over presented three times more risk of aortic injury than from other causes. Those with an aortic lesion also had a higher frequency of cardiopericardial, airway, and esophageal lesions.


Assuntos
Aorta/lesões , Mediastino/lesões , Ferimentos e Lesões/complicações , Adulto , Idoso , Análise de Variância , Estudos de Coortes , Feminino , Humanos , Masculino , Mediastino/fisiopatologia , Pessoa de Meia-Idade , Estatísticas não Paramétricas , Ferimentos e Lesões/fisiopatologia
20.
Amyloid ; 26(3): 139-147, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31210531

RESUMO

Objective: Amyloid A (AA) amyloidosis is found in humans and non-human primates, but quantifying disease risk prior to clinical symptoms is challenging. We applied machine learning to identify the best predictors of amyloidosis in rhesus macaques from available clinical and pathology records. To explore potential biomarkers, we also assessed whether changes in circulating serum amyloid A (SAA) or lipoprotein profiles accompany the disease. Methods: We conducted a retrospective study using 86 cases and 163 controls matched for age and sex. We performed data reduction on 62 clinical, pathological and demographic variables, and applied multivariate modelling and model selection with cross-validation. To test the performance of our final model, we applied it to a replication cohort of 2,775 macaques. Results: The strongest predictors of disease were colitis, gastrointestinal adenocarcinoma, endometriosis, arthritis, trauma, diarrhoea and number of pregnancies. Sensitivity and specificity of the risk model were predicted to be 82%, and were assessed at 79 and 72%, respectively. Total, low density lipoprotein and high density lipoprotein cholesterol levels were significantly lower, and SAA levels and triglyceride-to-HDL ratios were significantly higher in cases versus controls. Conclusion: Machine learning is a powerful approach to identifying macaques at risk of AA amyloidosis, which is accompanied by increased circulating SAA and altered lipoprotein profiles.


Assuntos
Amiloidose/diagnóstico , Aprendizado de Máquina/estatística & dados numéricos , Modelos Estatísticos , Proteína Amiloide A Sérica/metabolismo , Adenocarcinoma/diagnóstico , Adenocarcinoma/fisiopatologia , Amiloidose/sangue , Amiloidose/fisiopatologia , Animais , Artrite/diagnóstico , Artrite/fisiopatologia , Biomarcadores/sangue , Estudos de Casos e Controles , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Colite/diagnóstico , Colite/fisiopatologia , Diarreia/diagnóstico , Diarreia/fisiopatologia , Modelos Animais de Doenças , Endometriose/diagnóstico , Endometriose/fisiopatologia , Feminino , Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/fisiopatologia , Humanos , Macaca mulatta , Masculino , Estudos Retrospectivos , Fatores de Risco , Triglicerídeos/sangue , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/fisiopatologia
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