Damage Control Research Articles

FoxO1 signaling in B cell malignancies and its therapeutic targeting.

FoxO transcription factors (FoxO1, FoxO3a, FoxO4, FoxO6) are a highly evolutionary conserved subfamily of the 'forkhead' box proteins. They have traditionally been considered tumor suppressors, but FoxO1 also exhibits oncogenic properties. The complex nature of FoxO1 is illustrated by its various roles in B cell development and differentiation, immunoglobulin gene rearrangement and cell-surface B cell receptor (BCR) structure, DNA damage control, cell cycle regulation, and germinal center reaction. FoxO1 is tightly regulated at a transcriptional (STAT3, HEB, EBF, FoxOs) and post-transcriptional level (Akt, AMPK, CDK2, GSK3, IKKs, JNK, MAPK/Erk, SGK1, miRNA). In B cell malignancies, recurrent FoxO1 activating mutations (S22/T24) and aberrant nuclear export and activity have been described, underscoring the potential of its therapeutic inhibition. Here, we review FoxO1's roles across B cell and myeloid malignancies, namely acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), follicular lymphoma (FL), diffuse large B cell lymphoma (DLBCL), mantle cell lymphoma (MCL), Burkitt lymphoma (BL), Hodgkin lymphoma (HL), and multiple myeloma (MM). We also discuss preclinical evidence for FoxO1 targeting by currently available inhibitors (AS1708727, AS1842856, cpd10).

Energy-Based Skin Rejuvenation: A Review of Mechanisms and Thermal Effects.

Energy-based photoelectric and ultrasonic devices are essential for skin rejuvenation and resurfacing in the field of plastic surgery and dermatology. Both functionality and appearance are impacted by factors that cause skin to age, and various energy types have variable skin penetration depths and modes of transmission. The objective is to advise safe and efficient antiaging treatment while precisely and sensitively controlling and assessing the extent of thermal damage to tissues caused by different kinds of energy-based devices. A literature search was conducted on PubMed to review the mechanisms of action and thermal effects of photoelectric and ultrasonic devices in skin remodeling applications. This paper reviews the thermal effects of energy-based devices in skin resurfacing applications, including the tissue level and molecular biochemical level. It seeks to summarize the distribution form, depth of action, and influencing factors of thermal effects in combination with the mechanisms of action of various types of devices. Accurate control of thermal damage is crucial for safe and effective skin remodeling treatments. Thorough investigation of molecular biochemical indicators and signaling pathways is needed for real-time monitoring and prevention of severe thermal injury. Ongoing research and technological advancements will improve the accuracy and control of thermal damage during treatments.

Understanding the spleen response of Russian sturgeon (Acipenser gueldenstaedtii) dealing with chronic heat stress and Aeromonas hydrophila challenge

Sturgeon aquaculture has grown in recent years, driven by increasing global demand for its highly valued products. Russian sturgeon (Acipenser gueldenstaedtii), recognised as one of the most valuable species for caviar production, is farmed in several warm-temperate regions. However, the substantial temperature increase due to global warming represents a challenge for developing sturgeon aquaculture. Previously we demonstrated that Russian sturgeon under chronic heat stress (CHS) exhibited a liver metabolic reprogramming to meet energy demands, weakening their innate defences and leading to increased mortality and economic losses. Here, we used RNA-seq technology to analyse regulated genes in the spleen of Russian sturgeons exposed to CHS and challenged with Aeromonas hydrophila. The assembly gave 253,415 unigenes, with 13.7 % having at least one reliable functional annotation. We found that CHS caused mild splenitis and upregulated genes related to protein folding, heat shock response, apoptosis and autophagy while downregulated genes associated with the cell cycle. The cell cycle arrest was maintained upon A. hydrophila challenge in heat-stressed fish, potentially inducing cell senescence. Surprisingly, immunoglobulin heavy and light chains were upregulated in the spleen of stressed sturgeons but not in those maintained at tolerable temperatures; however, no changes in IgM serum levels were observed in any condition. Our findings indicate that long-term exposure to non-tolerable temperatures induced a heat shock response and activated apoptosis and autophagy processes in the spleen. These mechanisms may enable the control of tissue damage and facilitate the recycling of cell components in a condition where the nutrient supply by the liver might be insufficient. Stressed sturgeons challenged with A. hydrophila maintain these mechanisms, which could culminate in cellular senescence.

Design theory of self-centering column foot joint with dog bone weakened flange cover plate

Basing on the concept of post-earthquake repairability, plastic damage control, and self-centering, this study introduces a novel self-centering column foot joint with dog bone weakened flange cover plate (FCP) for prefabricated steel structure. The method and design theory for the target yield load and initial stiffness of the new joint were established. Parametric research was conducted using finite element simulation to assess the influence of the dog bone weakened FCP thickness, initial cable force, and axial compression ratio on the bearing performance of the new joint, thereby verifying the above method and theory. The results reveal the accuracy of the proposed method for determining the target yield load and initial stiffness, and provide practical design guidance for the new joint. The design theory values of the new joint and the simulation values demonstrate an error within 10%, which satisfies the engineering accuracy requirements. The corresponding procedures and suggestions for the design theory of this new joint were finally provided. Based on design theory, the overall plastic damage concentrates on the dog bone weakened FCP, successfully controlled by the new joint design, ensuring minimal damage to the main structure and demonstrating good bearing capacity and self-centering performance.

Гиповолемический шок у взрослых. Клинические рекомендации Общероссийской общественной организации «Федерация анестезиологов и реаниматологов»

The article presents the main provisions of clinical guidelines for the diagnosis and treatment of hypovolemic shock in adults, approved by the All-Russian public organization "Federation of Anesthesiologists and Resuscitators" in 2024. The relevance of the problem is associated with a significant prevalence and high mortality rates in hypovolemic shock. The recommendations include issues of etiology, pathogenesis, clinical picture, methods of laboratory and instrumental diagnostics of hypovolemic shock. The features of intensive care for hypovolemic shock are presented, including approaches to the administration of vasopressor and inotropic drugs, recommendations for the choice of infusion and adjuvant therapy, including the correction of coagulopathy in hemorrhagic shock. The issues of resuscitation damage control strategy are discussed. The criteria for the quality of medical care for adult patients with hypovolemic shock and algorithms for the doctor's actions in the diagnosis and intensive care of patients with hypovolemic shock are presented.

Mitochondrial dysfunction is a key link involved in the pathogenesis of sick sinus syndrome: a review.

Sick sinus syndrome (SSS) is a grave medical condition that can precipitate sudden death. The pathogenesis of SSS remains incompletely understood. Existing research postulates that the fundamental mechanism involves increased fibrosis of the sinoatrial node and its surrounding tissues, as well as disturbances in the coupled-clock system, comprising the membrane clock and the Ca2+ clock. Mitochondrial dysfunction exacerbates regional tissue fibrosis and disrupts the functioning of both the membrane and calcium clocks. This plays a crucial role in the underlying pathophysiology of SSS, including mitochondrial energy metabolism disorders, mitochondrial oxidative stress damage, calcium overload, and mitochondrial quality control disorders. Elucidating the mitochondrial mechanisms involved in the pathophysiology of SSS and further investigating the disease's mechanisms is of great significance.

Essential public health competencies in nursing during the COVID-19 pandemic: A Delphi study

Background & Aim: Nursing practice, characterized by its multifaceted nature, encompasses diverse settings and situations in public health, making it difficult to clearly define the role of nurses in this setting. The study aimed to determine the applicability and relevance of the Regional Core Competency Framework for Public Health in nursing practice during the COVID-19 pandemic. Methods & Materials: Study based on the Delphi methodology, a structured approach to the systematic collectión of expert opinions, to obtain group agreements. Twenty-one nurses working in public health areas during the pandemic participated. Results: The competencies most applied by the nurses were in the domain of health situation analysis and surveillance and risk and damage control. 95% of the nurses were involved in care actions to prevent contagion; 71% analyzed social determinants of health, 100% were involved in the domain of policies, planning, regulation, and control, and 86% in the domain of health promotion. 89% made decisions to favor access to preventive and health care services. 78% valued social participation actions and 76% implemented immediate responses to COVID-19. Conclusion: The main public health competencies used by nursing for dealing with the COVID-19 pandemic are the management of educational processes, health promotion, primary health care, analysis of social determinants, management of health policies, information analysis, and management of immediate responses to challenges generated by COVID-19.

Numerical simulation of the temporal and spatial evolution of sandstone pore type reservoir damage types and severity

During the oilfield development process, various factors can cause different types of reservoir damage, leading to reduced oil well production or even shutdown, and decreased water injection capacity in water wells, resulting in significant economic losses for the oilfield. However, formation damage control measures must be based on the quantitative diagnosis of the types and degrees of reservoir damage. This paper establishes a spatiotemporal evolution numerical model for 12 common types of damage during the oil and gas exploration and development process, based on the material balance theory and Fick’s diffusion law in reservoir damage processes. This model achieves numerical simulation of the degree of various reservoir damage types in different spatiotemporal domains. The overall damage degree of a specific well’s evolution with time and space is further simulated in simple superposition way. The sequential core flow experiment was carried out in the laboratory, and then compared with the calculation results. The accuracy is above 90%. Finally, using field test data, the simulation results show a 95% or higher degree of agreement with the actual field measurements, proving that the reservoir damage spatiotemporal evolution quantitative simulation technology established in this paper has high accuracy and practicality.

Effects of Roller Milling Parameters on Wheat-Flour Damaged Starch: A Comprehensive Passage Analysis and Response-Surface Methodology Optimization.

Damaged starch typically arises from mechanical damage caused by the action of the roller mills during the wheat flour milling process. The content of resulting damaged starch in the flour significantly influences its characteristics, emphasizing the importance of understanding and controlling the formation of damaged starch for the production of specialized flours. A detailed passage analysis from three different commercial mills revealed that starch damage control is primarily achievable at front passages of the sizing and reduction system, which generate the majority of the flour release in the mill. Also, it revealed that damaged starch content increases progressively from the initial to the final passages during milling in the break, sizing and reduction system. To investigate the effects of milling parameters on damaged starch, flour yield, and energy consumption, a three-level and three-variable Box-Behnken experimental design with response surface methodology was applied. As independent variables roll gap (0.05-0.35 mm), feed rate (0.15-0.35 kg/cm min), and fast roll speed (400-800 rpm) were employed. The obtained models were utilized to optimize milling conditions for producing flours with special characteristics.

Improving communication during damage control surgery: a survey of adult major trauma centres in England.

Deficiencies in non-technical skills can severely impede the functioning of teams in high-intensity scenarios, such as in damage control surgery for the critically injured trauma patient. Truncated preoperative checklists, modified from the standard World Health Organization preoperative checklist, and situational reporting at intervals during surgery are long-established practices in the military, and are recommended in the National Health Service guidelines on major incidents. These tools allow the multiprofessional team to create a shared mental model of the anaesthetic and operative plan, thereby improving team efficiency. Our aim was to establish whether adult major trauma centres in England are using truncated preoperative checklists and situational reporting for damage control surgery. An online survey was devised and distributed via the national programme of care for trauma in November 2020. Responses were received from all 23 adult major trauma centres in England. Nine centres (39.1%) reported using a truncated preoperative checklist for damage control surgery albeit in a variety of formats. Common components were blood products received and/or available, presence of allergies, tranexamic acid and antibiotic administration, availability of viscoelastic tests, equipment required, availability of cell saver, role allocation and reference to other personnel needed, and discussion of the plan. Twelve centres (52.2%) have formal policies in place for situational reporting. Again, these were in multiple formats but all focused on patient physiology to direct surgical planning. We have identified key components to advanced communication aids for damage control surgery, providing a foundation on which other major trauma centres can build their own versions of these potentially lifesaving tools.

A starry night: a case report of severe liver injury due to a close-range shotgun blast in Argentina.

This report presents the case of a 20-year-old man who sustained a severe liver injury from a closerange shotgun blast. A prompt medical intervention, including damage control exploratory laparotomy and surgical debridement, was undertaken due to the extent of liver damage. Despite challenges such as a nondirected biliary fistula and extensive liver parenchymal injury, comprehensive surgical management led to successful treatment. Postoperative complications, including biloma and fungal infection, were managed appropriately, highlighting the importance of vigilant follow-up care. The case underscores the complexity of managing severe liver trauma and emphasizes the evolving role of trauma damage control strategies and minimally invasive procedures in achieving favorable outcomes.

Temporary osteosynthesis of the tibial bones in repair of multiple and combined injuries

Background The incidence of injury worldwide remains high, with a global estimate of 6763 cases per 00,000 population (95 % confidence interval 6412–7147). Trauma to the limbs is a common injury to an individual anatomical area during multiple or combined trauma that accounts for 40 % to 85.2 % of cases. Assessment of the effectiveness of different fixation options and development of treatment algorithms are essential for patients with tibial fractures and multiple (combined) injuries.The objective was to determine how often temporary tibia fixation is applied for patients with multiple and combined injuries.Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru), the National Library of Medicine (www.pubmed.org), CyberLeninka between 2008 and 2023 using search words and phrases: tibial injuries, osteosynthesis of lower limbs, multiple injuries, combined injuries, temporary osteosynthesis of the tibial bones.Results and discussion A differentiated approach to the repair of bone fractures resulting from multiple and combined injuries is mostly common with the choice of fixation technique depending on the severity of injury and the severity of the patient’s condition. The definitive internal bone fixation is normally used for stable patients, “damage control” strategy is secured for borderline and severe cases using primary temporary external fixation followed by staged surgical intervention. There is no generally accepted strategy for the use of early mobilization of long bone fractures as a component of anti-shock measures in a polytrauma patient.Conclusion Certain issues remain unresolved, including the use of osteosynthesis for tibial fractures in some cohorts of patients, the optimal time of transition to definitive internal fixation, the possibility of using extrafocal osteosynthesis as a definitive treatment, the optimal configuration and assemblies to be employed. The lack of high-quality randomized controlled trials in this field is an important limitation.

Effects of Local Hypothermia on Limb Viability in a Swine Model of Acute Limb Ischemia During Prolonged Damage-Control Resuscitation.

New strategies are needed to mitigate further tissue injury during traumatic limb ischemia in cases requiring damage control resuscitation (DCR). Little is known about the pathophysiology and injury course in acute limb ischemia (ALI) with DCR in polytraumatized casualties. We therefore investigated the effects of therapeutic limb hypothermia in a swine model of ALI and DCR. Fifteen swine underwent a published 6-hour DCR protocol of hemorrhage and then resuscitation. After hemorrhage, animals were randomized to 5oC or 15oC cooling of one hindlimb; the contralateral limb serving as an uncooled control. Physiologic variables, limb temperature, and limb tissue metabolites (glucose, lactate, and pyruvate) were measured throughout the DCR protocol. Muscle and nerve biopsies were obtained after the 6-hour protocol. Lactate and pyruvate levels were significantly lower in the cooled limbs than in the uncooled control limbs but did not differ between the 5oC and 15oC groups. Tissue glucose levels did not differ between the 5oC group, the 15oC group, and controls. Mean histologic muscle score was significantly higher in the 5oC group than in controls (p = 0.03). Mean nerve histology scores did not differ between the 5oC and paired control limbs, or between the mean muscle and nerve histology scores of the 15oC and paired control limbs. Cooling to 15oC significantly reduced local tissue metabolites compared to paired controls, while producing no significant increase in histologic damage, whereas cooling to 5oC increased histologic muscle damage. These results suggest an approach to prevention of ischemic injury through local hypothermia but warrant further functional testing.

CT imaging of clinically significant abdominopelvic injuries in the damage control surgery patient.

Damage Control Surgery (DCS) refers to a staged laparotomy performed in patients who have suffered severe blunt or penetrating abdominopelvic trauma with the goal of managing critical injuries while avoiding life threatening metabolic derangements. Within 24h of the initial laparotomy, computed tomography (CT) is used to assess the full extent of injuries. The purpose of this study was to assess the incidence of clinically significant unknown abdominopelvic injuries which required further dedicated surgical or interventional radiology management and failed surgical repairs identified on CT following initial laparotomy. CT findings were correlated with surgical findings from the initial and subsequent staged laparotomy to determine known and unknown injuries. Frequency and percentage analyses was performed. Out of 63 patients who underwent DCS with an open abdomen following initial laparotomy and subsequent CT within 24h, a total of 13 clinically significant abdominopelvic injuries were identified in 12 patients. Seven clinically significant injuries were identified in seven patients (11.1% of patients) in surgically explored areas. Six clinically significant injuries were identified in six patients (9.5%) in surgically unexplored areas. Four instances of failed initial surgical repair were identified in four patients (6.3%) involving the liver and gastrointestinal tract. Overall, 23.8% of the DCS patient population had an actionable finding on the post laparotomy CT. CT demonstrated value for identifying the extent of clinically significant abdominopelvic injuries and evidence of failed initial surgical repair, which informed surgical planning for subsequent laparotomy. The authors advocate for performing CT in post-DCS patients with an open abdomen as soon as possible following correction of metabolic and hemodynamic derangements.

Peri-operative strategy in resuscitation of unstable injured surgical patients: a primer.

Trauma remains a leading cause of death, both for individuals under 40 in North America, and globally, where it contributes to ~10% of deaths annually. Thoughtful, timely, balanced resuscitation, especially in the peri-operative period for unstable injured surgical patients, is vital for optimizing outcomes. The advanced trauma life support protocol plays a pivotal role in early evaluation and management, emphasizing hemorrhage control and resuscitation strategies. This narrative review provides a structured, evidence-based framework aimed at enhancing the educational experience of surgical trainees. It outlines key principles in peri-operative trauma resuscitation, emphasizing timely intervention, goal-directed fluid therapy, and damage control surgery (DCS) to improve patient outcomes. A comprehensive Scale for Quality Assessment of Narrative Review Articles -guideline compliant literature search was conducted using PubMed and Google Scholar for English-language articles published between January 2000 and February 2024. The search included relevant medical subject headings terms. Additional studies were identified from reference lists. Extracted data were reviewed and organized using thematic analysis, focusing on historical perspectives, evidence-based practices, and the concept of DCS. Key findings from the 55 relevant studies selected underscore the importance of balanced fluid and blood product administration, the use of permissive hypotension in hemorrhagic shock, and the application of DCS principles. This review highlights educational strategies that foster a deeper understanding of trauma resuscitation practices, offering practical insights through case studies and technological innovations. This review serves as an educational resource for surgical trainees, equipping them with a robust understanding of evidence-based trauma resuscitation. By integrating historical context, modern practices, and emerging technologies, the review aims to enhance both the theoretical knowledge and practical skills necessary for managing unstable trauma patients. Emphasis is placed on interdisciplinary teamwork, continuous education, and personalized resuscitation strategies to improve clinical outcomes.

Damage Control Resuscitation in Traumatic Hemorrhage: Comment.

Damage Control Resuscitation in Traumatic Hemorrhage: Comment.

Damage Control Resuscitation in Traumatic Hemorrhage: Comment.

Damage Control Resuscitation in Traumatic Hemorrhage: Comment.

Retrospective Observational Analysis of Computed Tomography Scans of Trauma Patients in Overseas Operations (SCANOPEX Study).

High-intensity conflicts are on Europe's doorstep. The French expertise in the medical management of frontline casualties in overseas operations is well established. However, in the management of severe trauma, we lack data on the injuries identified by body scanners in the field. Understanding the associations between injury mechanisms and radiological lesions would enable us to anticipate medical and surgical management. To study this possible link, we collected and interpreted scanogaphic data and analyzed them according to lesion mechanisms, following the algorithm MARCH used to implement the concept of Damage Control Resuscitation, which includes life-saving measures to ensure that the wounded reach medical-surgical facilities alive. This retrospective monocentric study collected data from body scanners performed in overseas operations between June 2011 and September 2023. Inclusion criteria were to be French military personnel and to have undergone a whole-body scanner in a theater of overseas operations. Exclusion criteria were to have died before the scan, to be foreign, non-military and a minor. Of 164 available files, 96 were eligible, 1 patient declared aged 70 years was excluded, and 95 files were retained. In our population, 18% of injured patients had a spinal fracture. Compared with road traffic accident casualties, improvised explosive device casualties were the most severely injured patients arriving alive at computed tomography, with a relative risk of Injury Severity Score > 8 of 2.29 [1.09-4.80] (P = .019). Improvised explosive device casualties had a relative risk of airway injuries of 2.57 [1.03-6.39] (P = .030), injuries leading to functional impairment of 3.21 [1.17-8.82] (P =.013), injuries leading to infection of 2.14 [1.21-3.76] (P = .0045), and injuries leading to shock of 3.21 [0.96-10.70] (P = .039). Deep metal splinters were only found in the improvised explosive device group. Preparing the medical corps to deal with war casualties is fundamental. Our study shows that it is essential to consider the mechanism of injury to understand the casualty better and predict potential injuries. In addition, the study of postmortem scans could greatly help analyze potentially avoidable deaths.

Damage control thoracic surgery: What you need to know.

Damage control surgery in trauma prioritizes patient stabilization through an initial temporizing surgical approach to rapidly control hemorrhage and contamination, minimizing intraoperative time to allow for resuscitation and the correction of hypothermia, coagulopathy, and acidosis in the intensive care unit. This is followed by definitive repair of injuries once physiological parameters have improved. While damage control techniques for traumatic intra-abdominal and extremity injuries are well established and frequently utilized, the same cannot be said for damage control thoracic surgery. The complexity of thoracic injuries, the intricate decision making process, the level of surgical expertise required, and potential complications make damage control thoracic surgery particularly challenging. However, advances in surgical techniques, improvements in perioperative care, and the emergence of adjuncts such as extracorporeal membrane oxygenation have significantly enhanced decision making and underscored the importance of timely and decisive intervention in damage control thoracic surgery to optimize patient outcomes. This review aims to provide a comprehensive overview of damage control thoracic surgery, detailing the principles, indications, operative techniques, perioperative management, and the integration of advanced therapies to improve outcomes in patients with severe thoracic injuries.

Prolonged Time-to-antihypertensive Therapy Worsens Organ Damage and Blood Pressure Control in Arterial Hypertension.

Delay in arterial hypertension (AH) diagnosis and late therapy initiation may affect progression towards hypertensive-mediated organ damage (HMOD) and blood pressure (BP) control. We aimed to assess the impact of time-to-therapy on BP control and HMOD in patients receiving AH diagnosis. We analysed data from the Campania Salute Network, a prospective registry of hypertensive patients (NCT02211365). At baseline visit, time-to-therapy was defined as the interval between the first occurrence of BP values exceeding guidelines-directed thresholds and therapy initiation; HMOD included left ventricular hypertrophy (LVH), carotid plaque, or chronic kidney disease. Optimal BP control was considered for average values < 140/90 mmHg. Low-risk profile was defined as grade I AH without additional cardiovascular risk factors. From 14,161 hypertensive patients, we selected 1,627 participants who were not on antihypertensive therapy. This population was divided into two groups based on the median time-to-therapy (≤ 2 years n = 1,009, > 2 years n = 618). Patients with a time-to-therapy > 2 years had higher risk of HMOD (adjusted odds ratio, aOR:1.51, 95%, CI:1.19-1.93, p < 0.001) due to increased risks of LVH (aOR:1.43, CI:1.12-1.82, p = 0.004), carotid plaques (aOR:1.29, CI:1.00-1.65, p = 0.047), and chronic kidney disease (aOR:1.68, CI:1.08-2.62, p = 0.022). Time-to-therapy > 2 years was significantly associated with uncontrolled BP values (aOR:1.49, CI:1.18-1.88, p < 0.001) and higher number of antihypertensive drugs (aOR:1.68, CI:1.36-2.08, p < 0.001) during follow-up. In low-risk subgroup, time-to-therapy > 2 years did not impact on BP control and number of drugs. In hypertensive patients, a time-to-therapy > 2 years is associated with HMOD and uncontrolled BP.