Notes

Steatosis, inflammasome upregulation, along with fibrosis are generally attenuated throughout miR-155 poor rodents in a high fat-cholesterol-sugar diet-induced type of NASH.
Extracellular vesicles (EVs) isolated from cardiosphere-derived cells (CDC-EVs) are coming to light as a unique cell-free therapeutic. Because of their novelty, however, there still exist prominent gaps in knowledge regarding their therapeutic potential. Herein the therapeutic potential of CDC-EVs in a rat model of acute traumatic coagulopathy induced by multiple injuries and hemorrhagic shock is outlined.

Extracellular vesicle surface expression of procoagulant molecules (tissue factor and phosphatidylserine) was evaluated by flow cytometry. Extracellular vesicle thrombogenicity was tested using calibrated thrombogram, and clotting parameters were assessed using a flow-based adhesion model simulating blood flow over a collagen-expressing surface. The therapeutic efficacy of EVs was then determined in a rat model of acute traumatic coagulopathy induced by multiple injuries and hemorrhagic shock.

Extracellular vesicles isolated from cardiosphere-derived cells are not functionally procoagulant and do not s.
Although contrast-enhanced abdominal computed tomography (CEACT) is still considered the gold standard for the assessment of suspected acute diverticulitis, in recent years the use of point-of-care ultrasound (POCUS) has been spreading more and more in this setting. The aim of this study is to compare CEACT to POCUS for the diagnosis and staging of suspected acute diverticulitis.

This is a prospective study conducted on 55 patients admitted to the Emergency Department of two Italian Hospitals with a clinical suspicion of acute diverticulitis between January 2014 and December 2017. All the patients included underwent POCUS first and CEACT immediately afterwards, with the diagnosis and the staging reported according to the Hinchey (H) classification modified by Wasvary et al. Three surgeons performed all the POCUS and the same two radiologists retrospectively analyzed all the CEACT images. The radiologists were informed of the clinical suspicion but unaware of the POCUS findings. The CEACT was used as the gold standard for the comparison.

The final cohort included 30 (55%) females and 25 (45%) males. The median age was 62 (24-88) and the median body mass index was 26 (19-42).Forty-six out of 55 patients had a confirmed diagnosis of acute diverticulitis on both POCUS and CEACT, whereas in seven patients the diagnosis was not confirmed by both methods. POCUS sensitivity and specificity were 98% and 88% respectively. POCUS positive and negative predictive values were 98% and 88% respectively. POCUS accuracy was 96%.POCUS classified 33 H1a, 11 H1b, 1 H2 and 1 H3 acute diverticulitis. This staging was confirmed in all patients but three (93%) by CEACT.

Point-of-care ultrasound appeared a reliable technique for the diagnosis and the staging of clinically suspected H1 and H2 acute diverticulitis. It could contribute in saving time and resources and in avoiding unnecessary radiation exposure to most patients.

Level III.

Diagnostic test.
Diagnostic test.
Police transport (PT) of penetrating trauma patients decreases the time between injury and trauma center arrival. PI3K activator Our study objective was to characterize trends in the rate of PT and its impact on mortality. We hypothesized that PT is increasing and that these patients are more injured.

We conducted a single-center, retrospective cohort study of adult (≥18 years) patients presenting with gunshot wounds (GSWs) to a level 1 center from 2012 to 2018. Patients transported by police or ambulance (emergency medical service [EMS]) were included. The association between mode of transport (PT vs. EMS) and mortality was evaluated using χ2, t tests, Mann-Whitney U tests, and logistic regression.

Of 2,007 patients, there were 1,357 PT patients and 650 EMS patients. Overall in-hospital mortality was 23.7%. The rate of GSW patients arriving by PT increased from 48.9% to 78.5% over the study period (p < 0.001). Compared with EMS patients, PT patients were sicker on presentation with lower initial systolic blood pressure (98 vs. 110, p < 0.001), higher Injury Severity Score (median [interquartile range], 10 [2-75] vs. 9 [1-17]; p < 0.001) and more bullet wounds (3.5 vs. 2.9, p < 0.001). Police-transported patients more frequently underwent resuscitative thoracotomy (19.2% vs. 10.0%, p < 0.001) and immediate surgical exploration (31.3% vs. 22.6%, p < 0.001). There was no difference in adjusted in-hospital mortality between transport groups. Of patients surviving to discharge, PT patients had higher Injury Severity Score (9.6 vs. 8.3, p = 0.004) and lower systolic blood pressure on arrival (126 vs. 130, p = 0.013) than EMS patients.

Police transport of GSW patients is increasing at our urban level 1 center. Compared with EMS patients, PT patients are more severely injured but have similar in-hospital mortality. Further study is necessary to understand the impact of PT on outcomes in specific subsets in penetrating trauma patients.

Epidemiological, level III.
Epidemiological, level III.Endovascular hemostasis is commonplace with many practitioners providing services. Accruing sufficient experience during training could allow acute care surgeons (ACS) to expand their practice. We quantified case load and training opportunities at our center, where dedicated dual-trained ACS/vascular surgery faculty perform these cases. Our aim was to assess whether ACS fellows could obtain sufficient experience in 6 months of their fellowship in order to certify in these techniques, per the requirements of other specialties.
We performed a retrospective case series where we reviewed 6 years (2013-2018) of endovascular activity at an academic, level I trauma center quantifying arterial access, angiography, embolization, stent and stent graft placement, and IVC filter procedures. This was compared to the certification requirements for interventional radiology, vascular surgery, cardiothoracic surgery, and interventional cardiology.

Between 2013 and 2018, 1179 patients with a mean ± SD ISS of 22.47±13.24, underwent 4960 procedures. Annual rates per procedure, expressed as median (IQR), were arterial access 193.5 (181 - 195.5), diagnostic angiography 352 (321.5 - 364.5), embolization 90.5 (89.25 - 93.25), stent placement 24 (13.5 - 29.25), and IVC filter procedures 16.5 (10 - 23.75). Our 6-month case volume exceeded or was within 85% of the required number of cases for vascular surgery and interventional radiology training, with the exception of stent-graft deployment for both specialties, and therapeutic procedures for vascular surgery.

The case volume at a large trauma center with a dedicated endovascular trauma service is sufficient to satisfy the case requirements for endovascular certification. Our trainees are already acquiring this experience informally. An endovascular trauma curriculum should now be developed to support certification within ACS fellowship training.

Level IV.

Retrospective Case Series.
Retrospective Case Series.
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