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Chest Mar 2019Tracheobronchial injury is a rare but a potentially high-impact event with significant morbidity and mortality. Common etiologies include blunt or penetrating trauma and... (Review)
Review
Tracheobronchial injury is a rare but a potentially high-impact event with significant morbidity and mortality. Common etiologies include blunt or penetrating trauma and iatrogenic injury that might occur during surgery, endotracheal intubation, or bronchoscopy. Early recognition of clinical signs and symptoms can help risk-stratify patients and guide management. In recent years, there has been a paradigm shift in the management of tracheal injury towards minimally invasive modalities, such as endobronchial stent placement. Although there are still some definitive indications for surgery, selected patients who meet traditional surgical criteria as well as those patients who were deemed to be poor surgical candidates can now be managed successfully using minimally invasive techniques. This paradigm shift from surgical to nonsurgical management is promising and should be considered prior to making final management decisions.
Topics: Bronchi; Conservative Treatment; Humans; Minimally Invasive Surgical Procedures; Patient Selection; Stents; Trachea; Wounds and Injuries
PubMed: 30059680
DOI: 10.1016/j.chest.2018.07.018 -
Shock (Augusta, Ga.) Apr 2016In the United States trauma is the leading cause of mortality among those under the age of 45, claiming approximately 192,000 lives each year. Significant personal... (Review)
Review
In the United States trauma is the leading cause of mortality among those under the age of 45, claiming approximately 192,000 lives each year. Significant personal disability, lost productivity, and long-term healthcare needs are common and contribute 580 billion dollars in economic impact each year. Improving resuscitation strategies and the early acute care of trauma patients has the potential to reduce the pathological sequelae of combined exuberant inflammation and immune suppression that can co-exist, or occur temporally, and adversely affect outcomes. The endothelial and epithelial glycocalyx has emerged as an important participant in both inflammation and immunomodulation. Constituents of the glycocalyx have been used as biomarkers of injury severity and have the potential to be target(s) for therapeutic interventions aimed at immune modulation. In this review, we provide a contemporary understanding of the physiologic structure and function of the glycocalyx and its role in traumatic injury with a particular emphasis on lung injury.
Topics: Adolescent; Adult; Age Factors; Animals; Child; Child, Preschool; Endothelium, Vascular; Epithelium; Female; Glycocalyx; Humans; Immunomodulation; Inflammation; Male; Resuscitation; Trauma Severity Indices; United States; Wounds and Injuries
PubMed: 26513707
DOI: 10.1097/SHK.0000000000000513 -
Topics in Spinal Cord Injury... 2017Spinal cord injury (SCI) may profoundly impact autonomic function producing a variable degree of dysfunction in cardiovascular, bronchopulmonary, sweating, bladder,... (Review)
Review
Spinal cord injury (SCI) may profoundly impact autonomic function producing a variable degree of dysfunction in cardiovascular, bronchopulmonary, sweating, bladder, bowel, and sexual function. The cardiovascular system is crucially important for sexual function, as it is responsible for blood flow shifts to cavernous and musculoskeletal tissue during sexual activity. This system is prone to 3 main abnormalities after SCI including low resting blood pressure (LRBP), orthostatic hypotension (OH), and autonomic dysreflexia (AD), all of which have important effects on sexual function. We review the current etiological mechanisms and manifestations of cardiovascular dysfunction after SCI and discuss how this is documented to impact sexual function in individuals living with SCI. All individuals with SCI at or above the T6 neurologic level have an increased risk of AD during sexual stimulation, with increasing risk associated with higher levels of injury and greater completeness of injury. AD can be silent, and individuals living with SCI should be aware of blood pressure values at baseline and during sexual activity. Clinicians performing vibrostimulation fertility procedures need to be aware of the risk of AD and consider pretreatment if needed. Researchers studying the cardiovascular response to sexual stimulation should consider continuous monitoring of blood pressure, as intermittent monitoring may underestimate true blood pressure values.
Topics: Autonomic Nervous System; Blood Pressure; Cardiovascular System; Heart Rate; Humans; Sexual Behavior; Spinal Cord Injuries
PubMed: 29339873
DOI: 10.1310/sci2301-11 -
Journal of Cardiothoracic Surgery Apr 2020Blunt thoracic aortic injury, a life-threatening concern, remains the second most common cause of mortality among all non-penetrating traumatic injuries, second only to... (Review)
Review
BACKGROUND
Blunt thoracic aortic injury, a life-threatening concern, remains the second most common cause of mortality among all non-penetrating traumatic injuries, second only to intracranial hemorrhage. Kinetic forces from the rapid deceleration are the impetus for the injury mechanism and are graded accordingly. Given the prevalence of trauma as a public health problem, contemporary management considerations are important.
MAIN BODY
Blunt thoracic aortic injury may be fatal if not diagnosed and treated expeditiously. Endovascular options allow safe and effective management of these dangerous injuries. This paper describes the overview of blunt thoracic aortic trauma, the epidemiology, presentation, diagnosis, and treatment options with a focus on endovascular management.
CONCLUSION
Blunt thoracic aortic injury requires a high index of suspicion based on mechanism of injury in the trauma population. Endovascular options have become the mainstay of blunt thoracic aortic injury treatment whenever feasible with satisfactory results and long-term outcomes.
Topics: Aorta, Thoracic; Diagnostic Imaging; Endovascular Procedures; Humans; Postoperative Complications; Treatment Outcome; Wounds, Nonpenetrating
PubMed: 32307000
DOI: 10.1186/s13019-020-01101-6 -
Seminars in Musculoskeletal Radiology Apr 2020The skin, nerves, and tendons are superficial anatomical structures that can easily be investigated with an ultrasound (US) examination in the emergency department (ED).... (Review)
Review
The skin, nerves, and tendons are superficial anatomical structures that can easily be investigated with an ultrasound (US) examination in the emergency department (ED). US evaluation is relatively underused in musculoskeletal evaluation when compared with other emergency applications, such as abdominal trauma, possible aortic aneurysm, and in the cardiovascular system. The aim of this article is to revise the main bone and soft tissue conditions that can be assessed using US in the ED.
Topics: Emergency Service, Hospital; Humans; Ultrasonography; Wounds and Injuries
PubMed: 32438442
DOI: 10.1055/s-0039-3402050 -
Journal of Vascular Surgery May 2012Blunt abdominal aortic injury (BAAI) is a rare injury with less than 200 cases in the current reported world literature, mostly in case report format. We sought to... (Review)
Review
BACKGROUND
Blunt abdominal aortic injury (BAAI) is a rare injury with less than 200 cases in the current reported world literature, mostly in case report format. We sought to describe the experience of a high-volume trauma center and to provide a contemporary review of the literature to better understand the natural history and management of this injury.
METHODS
This was a retrospective review of patients with BAAI between 1996 and 2010. Data collected included demographics, mechanism of injury, associated injuries, type of intervention, subsequent imaging, and follow-up. BAAI was classified by the presence of external aortic contour abnormality noted as an intimal tear, large intimal flap, pseudoaneurysm, or free rupture. Abdominal aorta zones of injury were classified by possible surgical approaches as zone I (diaphragmatic hiatus to superior mesenteric artery [SMA]), zone II (includes SMA and renal arteries), and zone III (from the inferior aspect of the renal arteries to the aortic bifurcation).
RESULTS
We identified 28 individuals (68% male) with BAAI (median age, 28.5; range, 6-61 years). The median injury severity score was 45 (range, 16-75), and 39% were hypotensive at presentation. BAAI presented as intimal tear (21%), large intimal flap (39%), pseudoaneurysm (11%), and free rupture (29%). Zone III was the most common location of injury. Management depended on the location and type of injury: nonoperative (32%), open aortic repair (36%), endovascular repair (21%), and multimodality (10%). Overall mortality was 32%. Most deaths occurred during the initial operative exploration. The mortality rate of free aortic rupture was 100%. Intimal tears resolved or remained stable. Median follow-up was 15.5 months (range, 8 days-7.5 years). Vascular complications due to repair included a thrombosed access femoral artery during an endovascular repair and death of a patient who underwent a hybrid repair.
CONCLUSIONS
This is the largest BAAI series described in the English literature at one institution. BAAIs range from intimal tears to free rupture, with outcomes and management correlating with type and location of injury. Nonoperative management with blood pressure control using β-blockers coupled with antiplatelet therapy and close follow-up is successful in individuals with intimal tears with minimal thrombus formation because they remain stable or resolve on follow-up. Free rupture remains a devastating injury, with 100% mortality. For all other categories of aortic injury, successful repair correlates with a favorable prognosis.
Topics: Adolescent; Adult; Aneurysm, False; Aorta, Abdominal; Aortic Aneurysm; Aortic Diseases; Aortic Rupture; Aortography; Cardiovascular Agents; Child; Endovascular Procedures; Female; Humans; Incidence; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; Severity of Illness Index; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures; Vascular System Injuries; Washington; Wounds, Nonpenetrating; Young Adult
PubMed: 22322120
DOI: 10.1016/j.jvs.2011.10.132 -
Development (Cambridge, England) Feb 2017The 6th EMBO conference on the Molecular and Cellular Basis of Regeneration and Tissue Repair took place in Paestum (Italy) on the 17th-21st September, 2016. The 160... (Review)
Review
The 6th EMBO conference on the Molecular and Cellular Basis of Regeneration and Tissue Repair took place in Paestum (Italy) on the 17th-21st September, 2016. The 160 scientists who attended discussed the importance of cellular and tissue plasticity, biophysical aspects of regeneration, the diverse roles of injury-induced immune responses, strategies to reactivate regeneration in mammals, links between regeneration and ageing, and the impact of non-mammalian models on regenerative medicine.
Topics: Aging; Animals; Biomechanical Phenomena; Central Nervous System; Electrophysiological Phenomena; Heart; Humans; Models, Biological; Regeneration; Regenerative Medicine; Signal Transduction; Wound Healing; Wounds and Injuries
PubMed: 28143842
DOI: 10.1242/dev.144279 -
The Journal of Spinal Cord Medicine Mar 2013Spinal cord injury (SCI) results in motor and sensory impairments that can be identified with the American Spinal Injury Association (ASIA) Impairment Scale (AIS).... (Review)
Review
Spinal cord injury (SCI) results in motor and sensory impairments that can be identified with the American Spinal Injury Association (ASIA) Impairment Scale (AIS). Although, SCI may disrupt autonomic neural transmission, less is understood regarding the clinical impact of decentralized autonomic control. Cardiovascular regulation may be altered following SCI and the degree of impairment may or may not relate to the level of AIS injury classification. In general, persons with lesions above T1 present with bradycardia, hypotension, and orthostatic hypotension; functional changes which may interfere with rehabilitation efforts. Although many individuals with SCI above T1 remain overtly asymptomatic to hypotension, we have documented deficits in memory and attention processing speed in hypotensive individuals with SCI compared to a normotensive SCI cohort. Reduced resting cerebral blood flow (CBF) and diminished CBF responses to cognitive testing relate to test performance in hypotensive non-SCI, and preliminary evidence suggests a similar association in individuals with SCI. Persons with paraplegia below T7 generally present with a normal cardiovascular profile; however, our group and others have documented persistently elevated heart rate and increased arterial stiffness. In the non-SCI literature there is evidence supporting a link between increased arterial stiffness and cognitive deficits. Preliminary evidence suggests increased incidence of cognitive impairment in individuals with paraplegia, which we believe may relate to adverse cardiovascular changes. This report reviews relevant literature and discusses findings related to the possible association between decentralized cardiovascular autonomic control and cognitive dysfunction in persons with SCI.
Topics: Autonomic Nervous System; Cardiovascular System; Cognition Disorders; Humans; Spinal Cord Injuries
PubMed: 23809520
DOI: 10.1179/2045772312Y.0000000056 -
Sports Health 2018Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition in the general population, with evidence suggesting that it may be more common among... (Review)
Review
CONTEXT
Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition in the general population, with evidence suggesting that it may be more common among athletes.
EVIDENCE ACQUISITION
Literature searches were performed on PubMed, MEDLINE, and Cochrane databases for the years 2000 to 2016 utilizing the following key search terms: ADHD, ADD, guidelines, diagnosis, athlete, sports, treatment, pharmacotherapy, stimulants, risk, cardiovascular effects, concussion, and traumatic brain injury (TBI).
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 4.
RESULTS
ADHD exists among athletes at all levels of play, and symptomatology overlaps significantly with that of concussion. Treatment with stimulants has cardiovascular effects and may not be permitted by the athlete's governing body. An athlete's level of competition and individual cardiovascular risk factors may therefore affect medication choices.
CONCLUSION
ADHD diagnosis and treatment are paramount to optimal quality of life and functioning in affected individuals. Pharmacologic treatment options should not specifically be avoided in athletes; however, stimulant use is an independent risk factor for heat illness. Concussion, a common athletic injury, may have an altered course in those affected by ADHD, specifically with regard to neurocognitive testing and recovery.
Topics: Athletes; Athletic Injuries; Attention Deficit Disorder with Hyperactivity; Brain Concussion; Cardiovascular System; Central Nervous System Stimulants; Humans; Risk Factors
PubMed: 29144831
DOI: 10.1177/1941738117742906 -
Hypertension (Dallas, Tex. : 1979) Sep 2016Kallistatin is an endogenous protein that exerts pleiotropic effects, including vasodilation and inhibition of angiogenesis, inflammation, oxidative stress, apoptosis,... (Review)
Review
Kallistatin is an endogenous protein that exerts pleiotropic effects, including vasodilation and inhibition of angiogenesis, inflammation, oxidative stress, apoptosis, fibrosis, and tumor progression. Through its two functional domains – an active site and a heparin-binding site – kallistatin regulates differential signaling pathways and a wide spectrum of biological functions. Kallistatin's active site is key for inhibiting tissue kallikrein activity, and stimulating the expression of endothelial nitric oxide synthase (eNOS), sirtuin 1 (SIRT1) and suppressor of cytokine signaling 3 (SOCS3). Kallistatin via its heparin-binding site blocks signaling pathways mediated by growth factors and cytokines, such as vascular endothelial growth factor (VEGF), tumor necrosis factor-α (TNF-α), high mobility group box-1 (HMGB1), Wnt, transforming growth factor-β (TGF-β), and epidermal growth factor (EGF). Kallistatin gene or protein delivery protects against the pathogenesis of hypertension, heart and kidney damage, arthritis, sepsis, influenza virus infection, tumor growth and metastasis in animal models. Conversely, depletion of endogenous kallistatin by neutralizing antibody injection exacerbates cardiovascular and renal injury in hypertensive rats. Kallistatin levels are markedly reduced in rodents with hypertension, sepsis, streptozotocin-induced diabetes, and cardiac and renal injury. Kallistatin levels are also diminished in patients with liver disease, septic syndrome, diabetic retinopathy, severe pneumonia, inflammatory bowel disease, and obesity, prostate and colon cancer. Therefore, circulating kallistatin levels may serve as a new biomarker for human diseases. This review summarizes kallistatin's protective roles and mechanisms in vascular and organ injury, and highlights the therapeutic potential of kallistatin for multiple disease states.
Topics: Animals; Biomarkers; Blood Pressure; Humans; Hypertension; Prognosis; Risk Assessment; Serpins; Treatment Outcome; Vascular System Injuries; Wounds and Injuries
PubMed: 27432868
DOI: 10.1161/HYPERTENSIONAHA.116.07861