Hemorrhagic Conditions Research Articles

Age-dependent changes of coagulation system parameters in pediatric patients of cardiosurgical profile

Objective. Estimate baseline coagulation profile values in patients scheduled for cardiosurgical intervention in age groups of pediatric population.Material and methods. The coagulation profile was analyzed in a complete selection of patients admitted to the intensive care department of Scientific Research Institute – Ochapovsky Regional Clinical Hospital #1 for the period from January to December 2018. The study includes 842 patients planned for cardiac surgery.Results. This study demonstrates the dependence of the basic parameters of the hemostasis system on age characteristics, mainly during the period of the first year of life. APPT values were similar in all age groups, whereas extended PV was recorded in patients less than one year.Conclusion. Evaluation of coagulation system parameters should be based on age-specific reference values. Understanding the concept of developing hemostasis is extremely important in conditions of optimal prevention, diagnosis and treatment of hemorrhagic and thrombotic conditions in the pediatric population.

Thyroid-related hormones as potential markers of hypoxia/ischemia

This study aimed to investigate the usefulness of the thyroid-related hormones as markers of acute systemic hypoxia/ischemia to identify deaths caused by asphyxiation due to neck compression in human autopsy cases. The following deaths from pathophysiological conditions were examined: mechanical asphyxia and acute/subacute blunt head injury; acute/subacute non-head blunt injury; sharp instrument injury as the hemorrhagic shock condition; drowning as alveolar injury; burn; and death due to cardiac dysfunction. Blood samples were collected from the left and right cardiac chambers and iliac veins, and serum triiodothyronine (T3), thyroxine (T4), thyroglobulin (Tg), and thyroid-stimulating hormone (TSH) levels were measured using electrochemiluminescence immunoassays. Two types of thyroid cell lines were used to confirm independent thyroid function under the condition of hypoxia (3% O2). The human thyroid carcinoma cell line (HOTHC) cell line derived from human anaplastic thyroid carcinoma and the UD-PTC (sample of the second resection papillary thyroid carcinoma) cell line derived from human thyroid papillary adenoma, which forms Tg retention follicles, were used to examine the secretion levels of T3, T4, and Tg hormones. The results showed a strong correlation between T3 and T4 levels in all blood sampling sites, while the TSH and Tg levels were not correlated with the other markers. Serum T3 and T4 levels were higher in cases of mechanical asphyxia and acute/subacute blunt head injury, representing hypoxic and ischemic conditions of the brain as compared to those in other causes of death. In the thyroid gland cell line, T4, T3, and Tg levels were stimulated after exposure to hypoxia for 10–30 min. These findings suggest that systemic advanced hypoxia/ischemia may cause a rapid and TSH-independent release of T3 and T4 thyroid hormones in autopsy cases. These findings demonstrate that increased thyroid-related hormone (T3 and T4) levels in the pathophysiological field may indicate systemic hypoxia/ischemia.

Recombinant Adiponectin Peptide Ameliorates Brain Injury Following Intracerebral Hemorrhage by Suppressing Astrocyte-Derived Inflammation via the Inhibition of Drp1-Mediated Mitochondrial Fission

Intracerebral hemorrhage (ICH) is a life-threatening subtype of cerebral stroke with high morbidity and mortality; however, effective treatment for ICH is still lacking. Adiponectin (APN) is a a kind of fat-derived plasma protein with beneficial effects in cerebrovascular disorders. In this study, we aimed to investigate the protective effects of recombinant APN peptide (APNp) on brain injury after ICH in adult male C57BL/6J mice and further explored the underlying molecular mechanisms of these effects. APNp treatment exerted dose-dependent neuroprotective effects including improved neurological function, decreased brain edema, reduced neural apoptosis, and alleviated blood-brain barrier (BBB) disruption in ICH mice. We found the massive accumulation of APNp on reactive astrocytes around brain microvessels under hemorrhage conditions by immunofluorescence analysis. mRNA sequencing (mRNA-seq) and transcriptome analysis indicated that APNp significantly attenuated the inflammatory response and mitochondrial respiratory dysfunction in astrocytes. Further study revealed that this process was, at least in part, reliant on the inhibition of Drp1-mediated excessive mitochondrial fission. More specifically, APNp increased AMP-activated protein kinase (AMPK) activation-dependent Drp1 serine 637 (S637) phosphorylation, which inhibited the translocation of Drp1 to the mitochondrial membrane and reduced mitochondrial fragmentation and the production of mitochondrial superoxide, ultimately attenuating inflammatory brain injury induced by hemorrhage. In conclusion, we propose APNp as a potential therapeutic agent for ICH. We provide the first mechanistic evidence that APNp can modulate Drp1-mediated mitochondrial fission, which then contributes to alleviating astrocyte-derived inflammation.

The Correlation of Comorbidities on the Mortality in Patients with COVID-19: an Observational Study Based on the Korean National Health Insurance Big Data.

BackgroundMortality of coronavirus disease 2019 (COVID-19) is a major concern for quarantine departments in all countries. This is because the mortality of infectious diseases determines the basic policy stance of measures to prevent infectious diseases. Early screening of high-risk groups and taking action are the basics of disease management. This study examined the correlation of comorbidities on the mortality of patients with COVID-19.MethodsWe constructed epidemiologic characteristics and medical history database based on the Korean National Health Insurance Service Big Data and linked COVID-19 registry data of Korea Centers for Disease Control & Prevention (KCDC) for this emergent observational cohort study. A total of 9,148 patients with confirmed COVID-19 were included. Mortalities by sex, age, district, income level and all range of comorbidities classified by International Classification of Diseases-10 based 298 categories were estimated.ResultsThere were 3,556 male confirmed cases, 67 deaths, and crude death rate (CDR) of 1.88%. There were 5,592 females, 63 deaths, and CDR of 1.13%. The most confirmed cases were 1,352 patients between the ages of 20 to 24, followed by 25 to 29. As a result of multivariate logistic regression analysis that adjusted epidemiologic factors to view the risk of death, the odds ratio of death would be hemorrhagic conditions and other diseases of blood and blood-forming organs 3.88-fold (95% confidence interval [CI], 1.52–9.88), heart failure 3.17-fold (95% CI, 1.88–5.34), renal failure 3.07-fold (95% CI, 1.43–6.61), prostate malignant neoplasm 2.88-fold (95% CI, 1.01–8.22), acute myocardial infarction 2.38-fold (95% CI, 1.03–5.49), diabetes was 1.82-fold (95% CI, 1.25–2.67), and other ischemic heart disease 1.71-fold (95% CI, 1.09–2.66).ConclusionWe hope that this study could provide information on high risk groups for preemptive interventions. In the future, if a vaccine for COVID-19 is developed, it is expected that this study will be the basic data for recommending immunization by selecting those with chronic disease that had high risk of death, as recommended target diseases for vaccination.

Conocimiento sobre la transmisión y profilaxis de la Fiebre Amarilla en el municipio de São Paulo, Brasil

Yellow fever is an infectious non-contagious disease that can cause acute, febrile and hemorrhagic conditions. The State of São Paulo has experienced an epidemic in the last two years. As Brazil presents an extensive enzootic area for wild yellow fever, knowledge of the main forms of transmission and prophylaxis is fundamental to avoid new epidemics. This study evaluated the population's knowledge about these factors. Although Aedes aegypti has not promoted transmission of the disease in Brazil since 1942, most of the interviewees believe that it is the main vector, however, it is known that vaccination is the best way to prevent the disease.

Automated Assessment of Hematoma Volume of Rodents Subjected to Experimental Intracerebral Hemorrhagic Stroke by Bayes Segmentation Approach

Simulating a clinical condition of intracerebral hemorrhage (ICH) in animals is key to research on the development and testing of diagnostic or treatment strategies for this high-mortality disease. In order to study the mechanism, pathology, and treatment for hemorrhagic stroke, various animal models have been developed. Measurement of hematoma volume is an important assessment parameter to evaluate post-ICH outcomes. However, due to tissue preservation conditions and variables in digitization, quantification of hematoma volume is usually labor intensive and sometimes even subjective. The objective of this study is to develop an automated method that can accurately and efficiently obtain unbiased cerebral hematoma volume. We developed an application (MATLAB program) that can delineate the brain slice from the background and use the Hue information in the Hue/Saturation/Value (HSV) color space to segment the hematoma region. The segmentation threshold of Hue is calculated based on the Bayes classifier theorem so that the minimum error is mathematically ensured and automated processing is enabled. To validate the developed method, we compared the outcomes from the developed method with the hemoglobin content by the spectrophotometric assay method. The results were linearly correlated with statistical significance. The method was also validated by digital phantoms with an error less than 5% compared with the ground truth from the phantoms. Hematoma volumes yielded by the automated processing and those obtained by the operator's manual operation are highly correlated. This automated segmentation approach can be potentially used to quantify hemorrhagic outcomes in rodent stroke models in an unbiased and efficient way.

Oral health and cardiovascular disease risk factors and mortality of cerebral haemorrhage, cerebral infarction and unspecified stroke in elderly men: A prospective cohort study.

Background: Stroke mortality comprises different specific diagnoses as cerebral infarction, different haemorrhagic conditions and unspecified stroke. This study seeks to explore the prediction of oral health indicators versus known cardiovascular disease risk factors for stroke mortality. Methods: Altogether, 12,764 men aged 58 to 77 years were invited to the health screening Oslo II in the year 2000. It included general medical measurements and questionnaire information. Mortality data were supplied by Statistics Norway for the 6530 attending men. Cox proportional hazards regression analyses were used to establish prediction models for mortality. Results: Oral health by number of tooth extractions >10 was found to be an independent predictor for cerebral infarction hazard ratio = 2.92, 95% confidence interval (1.24-6.89). This was independent of HDL-Cholesterol (inversely) hazard ratio = 0.21, 95% confidence interval (0.06-0.76), frequent alcohol consumption (drinking 4-7 times per week) hazard ratio = 3.58, 95% confidence interval (1.40-9.13) and diabetes hazard ratio = 4.28, 95% confidence interval (1.68-10.89). Predictors for cerebral haemorrhage were age, hs-C-reactive protein and body mass index (inversely). Age and total cholesterol (inversely) were predictors for unspecified stroke. Conclusions: Oral health measured by number of tooth extractions >10 was an independent predictor for cerebral infarction in addition to age, HDL-C, hs-C-reactive protein and diabetes. The pattern of risk factors varied between the specific stroke diagnoses.

Portal phase alone is equivalent to multiphasic phase for CT diagnosis of acute non-traumatic pains in an emergency context.

To evaluate radiological diagnosis concordance between a simplified and a multiphasic computed tomography (MCT) protocol for patients presenting acute non-traumatic abdominal pains (ANTAE). During five consecutive months, all patients admitted in an emergency department for ANTAE were retrospectively included if they underwent MCT, including at least pre-contrast phase, late arterial phase (LAP), and portal venous phase (PVP). Clinical cases of suspected hemorrhagic conditions were secondarily excluded. For the study, two image sets, pre-contrast phase + LAP + PVP ± late phase called S1 and PVP alone called S2, were reviewed independently to give the most appropriate diagnosis with 5-point confidence scale. Diagnosis concordance and radiation dose were compared for each set of protocol by chi-square test. Linear mixed model was used to assess changes of diagnostic confidence and radiation dose. All in all, 196 patients were included. The kappa coefficient between S1 and S2 was excellent (98.5%, CI95% 95.6-99.7). Three errors due to an inappropriate protocol were observed (1.5%; CI95% = - 0.2 to 3.2%), 2 related to biliary tract obstruction causes and one due to gastric bleeding not suspected on clinical data. S2 was associated with a 61% decrease of the radiation dose (p = 0.01) with a mild decrease of the confidence scale (4.54 ± 0.05 versus 4.74 ± 0.03, p = 0.001). Using PVP-CT alone or MCT is equivalent for the diagnosis of ANTAE if suspected acute hemorrhages are excluded. A simplified CT protocol is associated with a dose decrease of 61%.

Meteorological factors for subarachnoid hemorrhage in the greater Düsseldorf area revisited: a machine learning approach to predict the probability of admission of patients with subarachnoid hemorrhage.

Reported data regarding the relation between the incidence of spontaneous subarachnoid hemorrhage (SAH) and weather conditions are conflicting and do so far not allow prognostic models. Admissions for spontaneous SAH (ICD I60.*) 2009-2018 were retrieved form our hospital data base. Historical meteorological data for the nearest meteorological station, Düsseldorf Airport, was retrieved from the archive of the Deutsche Wetterdienst (DWD). Airport is in the center of our catchment area with a diameter of approximately 100 km. Pearson correlation matrix between mean daily meteorological variables and the daily admissions of one or more patients with subarachnoid hemorrhage was calculated and further analysis was done using deep learning algorithms. For the 10-year period from January 1, 2009 until December 31, 2018, a total of 1569 patients with SAH were admitted. No SAH was admitted on 2400 days (65.7%), 1 SAH on 979 days (26.7%), 2 cases on 233 days (6.4%), 3 SAH on 37 days (1.0%), 4 in 2 days (0.05%), and 5 cases on 1 day (0.03%). Pearson correlation matrix suggested a weak positive correlation of admissions for SAH with precipitation on the previous day and weak inverse relations with the actual mean daily temperature and the temperature change from the previous days, and weak inverse correlations with barometric pressure on the index day and the day before. Clustering with admission of multiple SAH on a given day followed a Poisson distribution and was therefore coincidental. The deep learning algorithms achieved an area under curve (AUC) score of approximately 52%. The small difference from 50% appears to reflect the size of the meteorological impact. Although in our data set a weak correlation of the probability to admit one or more cases of SAH with meteorological conditions was present during the analyzed time period, no helpful prognostic model could be deduced with current state machine learning methods. The meteorological influence on the admission of SAH appeared to be in the range of only a few percent compared with random or unknown factors.

3210 Aortoenteric Fistula—Rare, Deadly and Obscure

INTRODUCTION: Small-bowel bleeding comprises a majority of obscure gastrointestinal bleeding, and is caused by various diseases. For its diagnosis, history-taking, physical examination, diagnostic testing such as cross-sectional imaging, followed by videocapsule endoscopy and deep enteroscopy are all used according to the severity of hemorrhage and patient condition. CASE DESCRIPTION/METHODS: A 74 year old male with an open AAA repair, CKD stage 3, diverticulosis, and ongoing overt obscure GI bleeding × 1.5 years s/p segmental small bowel resection was admitted for an episode of rectal bleeding with hemodynamic instability. He had innumerable upper endoscopies, colonoscopies, video capsule endoscopies and intraop enteroscopy with no clear etiology and had gotten over 70 units of packed RBCs. Records revealed He underwent repeat endoscopy and colonoscopy, but a video capsule endoscopy showed active bleeding in the sigmoid likely from diverticulosis and venous ectasias seen on CTA. He underwent sigmoid resection but bleeding recurred. He then underwent a provoked angiography which was normal. He continued to have bleeding episodes which was characterized by large volume hematochezia and hemodynamic instability. After extensive discussion he underwent a loop ileostomy to determine exact source of his bleeding (small bowel versus colon). Unfortunately 24 hours after surgery, he became unresponsive and developed large volume hematemesis which led to his demise. An autopsy was performed and showed a secondary aortoenteric fistula. This is perhaps one of the only are reported cases of AEF presenting as an obscure GI bleed. DISCUSSION: Development of an aortoenteric fistula (AEF) is a devastating and life-threatening condition, which is as difficult to diagnose as it is to treat. Fortunately, it is rare, most commonly seen as a delayed complication of aortic reconstruction. Two types are recognized: primary and secondary. Primary fistulas occur de novo between the aorta and bowel, most commonly duodenum. Secondary fistulas occur between an aortic graft and segment of bowel. Diagnosis of AEF requires a high index of suspicion in patients who present with either signs of infection or gastrointestinal hemorrhage.

Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions.

The rising trend in pregnancy-related deaths during the past 2 decades in the United States stands out among other high-income countries where pregnancy-related deaths are declining. Cardiomyopathy and other cardiovascular conditions, hemorrhage, and other chronic medical conditions are all important causes of death. Unintentional death from violence, overdose, and self-harm are emerging causes that require medical and public health attention. Significant racial/ethnic inequities exist in pregnancy care with non-Hispanic black women incurring 3 to 4 times higher rates of pregnancy-related death than non-Hispanic white women. Varied terminology and lack of standardized methods for identifying maternal deaths in the United States have resulted in nuanced data collection and interpretation challenges. State maternal mortality review committees are important mechanisms for capturing and interpreting data on cause, timing, and preventability of maternal deaths. Importantly, a thorough standardized review of each maternal death leads to recommendations to prevent future pregnancy-associated deaths. Key interventions to improve maternal health outcomes include 1) integrating multidisciplinary care for women with high-risk comorbidities during preconception care, pregnancy, postpartum, and beyond; 2) addressing structural racism and the social determinants of health; 3) implementing hospital-wide safety bundles with team training and simulation; 4) providing patient education on early warning signs for medical complications of pregnancy; and 5) regionalizing maternal levels of care so that women with risk factors are supported when delivering at facilities with specialized care teams.

341 The Significance of Pulse Pressure in the Early Phase of Hemorrhagic Pathological Conditions: An Observational Study Using the Japan Trauma Data Bank

341 The Significance of Pulse Pressure in the Early Phase of Hemorrhagic Pathological Conditions: An Observational Study Using the Japan Trauma Data Bank

Neuroprotective Methodologies of Co-Enzyme Q10 Mediated Brain Hemorrhagic Treatment: Clinical and Pre-Clinical Findings.

Cerebral brain hemorrhage is associated with the highest mortality and morbidity despite only constituting approximately 10-15% of all strokes classified into intracerebral and intraventricular hemorrhage where most of the patients suffer from impairment in memory, weakness or paralysis in arms or legs, headache, fatigue, gait abnormality and cognitive dysfunctions. Understanding molecular pathology and finding the worsening cause of hemorrhage will lead to explore the therapeutic interventions that could prevent and cure the disease. Mitochondrial ETC-complexes dysfunction has been found to increase neuroinflammatory cytokines, oxidative free radicals, excitotoxicity, neurotransmitter and energy imbalance that are the key neuropathological hallmarks of cerebral hemorrhage. Coenzyme Q10 (CoQ10), as a part of the mitochondrial respiratory chain can effectively restore these neuronal dysfunctions by preventing the opening of mitochondrial membrane transition pore, thereby counteracting cell death events as well as exerts an anti-inflammatory effect by influencing the expression of NF-kB1 dependent genes thus preventing the neuroinflammation and energy restoration. Due to behavior and biochemical heterogeneity in post cerebral brain hemorrhagic pattern different preclinical autologous blood injection models are required to precisely investigate the forthcoming therapeutic strategies. Despite emerging pre-clinical research and resultant large clinical trials for promising symptomatic treatments, there are very less pharmacological interventions demonstrated to improve post operative condition of patients where intensive care is required. Therefore, in current review, we explore the disease pattern, clinical and pre-clinical interventions under investigation and neuroprotective methodologies of CoQ10 precursors to ameliorate post brain hemorrhagic conditions.

Reactive microglia and astrocytes in neonatal intraventricular hemorrhage model are blocked by mesenchymal stem cells.

Severe intraventricular hemorrhage (IVH) in premature infants triggers reactive gliosis, causing acute neuronal death and glial scar formation. Transplantation of mesenchymal stem cells (MSCs) has often showed improved CNS recovery in an IVH model, but whether this response is related to reactive glial cells is still unclear. Herein, we suggest that MSCs impede the response of reactive microglia rather than astrocytes, thereby blocking neuronal damage. Astrocytes alone showed mild reactiveness under hemorrhagic conditions mimicked by thrombin treatment, and this was not blocked by MSC-conditioned medium (MSC-CM) in vitro. In contrast, thrombin-induced microglial activation and release of proinflammatory cytokines were inhibited by MSC-CM. Interestingly, astrocytes showed greater reactive response when co-cultured with microglia, and this was abolished in the presence of MSC-CM. Gene expression profiles in microglia revealed that transcript levels of genes for immune response and proinflammatory cytokines were altered by thrombin treatment. This result coincided with the robust phosphorylation of STAT1 and p38 MAPK, which might be responsible for the production and release of proinflammatory cytokines. Furthermore, application of MSC-CM diminished thrombin-mediated phosphorylation of STAT1 and p38 MAPK, supporting the acute anti-inflammatory role of MSCs under hemorrhagic conditions. In line with this, activation of microglia and consequent cytokine release were impaired in Stat1-null mice. However, reactive response in Stat1-deficient astrocytes was maintained. Taken together, our results demonstrate that MSCs mainly block the activation of microglia involving STAT1-mediated cytokine release and subsequent reduction of reactive astrocytes.

Anterior Temporal Approach for Clipping of Upper Basilar Artery Aneurysms: Surgical Techniques and Treatment Outcomes

Upper basilar artery (BA) aneurysms, which consist of basilar tip and BA-superior cerebellar artery aneurysms, are challenging to treat with microsurgical clipping. The anterior temporal approach is one surgical approach used to treat aneurysms in this region. Most previous reports on this approach have consisted of unruptured cases. Assessing mostly ruptured cases in this study, we describe the surgical technique, patient characteristics, and surgical outcomes. Twenty-three patients with aneurysms arising from the upper BA who received aneurysm clipping via an anterior temporal approach between December 2015 and January 2019 were retrospectively evaluated. The location of the aneurysms was the basilar tip in 15 patients (65.2%) and the BA-superior cerebellar artery junction in 8 patients (34.8%). Twenty-one patients (91.3%) presented with subarachnoid hemorrhage. Good outcomes (modified Rankin Scale score 0-2) at 3 months were achieved in 55.6% of all patients and in 80% of good-grade patients (World Federation of Neurosurgical Societies grades I-III) and patients with unruptured aneurysms. For patients with subarachnoid hemorrhage, a good outcome was achieved in 75% of good-grade patients. Postoperative transient oculomotor nerve palsy and thalamic infarctions were detected in 7 patients (30.4%) and 2 patients (8.7%), respectively. With appropriate case selection, the anterior temporal approach was effective and safe for clipping of upper BA aneurysms, especially under subarachnoid hemorrhage conditions.

Application effect of nursing intervention to prevent postpartum hemorrhage in natural parturient women

Objective To explore the application effect of nursing intervention to prevent postpartum hemorrhage in natural childbirth. Methods A total of 86 women who underwent natural childbirth in the hospital from December 2016 to November 2017 were selected as research objects.According to the random number table method, the patients were divided into the control group and the observation group, 43 cases of each group.The control group was given routine nursing.The observation group was added with comprehensive nursing intervention on the basis of the control group.A comprehensive evaluation was conducted on the condition of postpartum hemorrhage, postpartum adverse reactions, Self-Rating Anxiety Scale(SAS), Self-Rating Depression Scale(SDS)before and after nursing care in the two groups. Results The amount of bleeding at delivery, 2 hours postpartum and 12 hours postpartum in the observation group were significantly lower than those in the control group, and the differences were statistically significant(P<0.05). After nursing, 2 cases of maternal adverse reactions occurred in the observation group, accounting for 4.65%, which was significantly lower than that of the control group 25.58%, and the difference was statistically significant (P<0.05). The scores of SAS and SDS in the observation group were compared with those of the control group, and the differences were statistically significant (P<0.05). Conclusions Nursing intervention in the natural delivery of maternal application can reduce the amount of blood loss, relieve maternal negative psychology, reduce the incidence of adverse reactions.It is worth promoting the application. Key words: Nursing intervention; Postpartum hemorrhage; Natural childbirth; Adverse reaction; Application effect

Body Weight and Platelet Count Changes in Zidovudine Administered Wistar Albino Rats Treated with Ethanolic Extracts of Annona muricata and Fagara zanthoxyloide

Zidovudine administration either in single or fixed-dose combination usually results in a decrease in body weight and in some cases thrombocytopenia. The present study investigated the body weight and platelet count changes observed in zidovudine pre-administered Wistar albino rats on treatment with ethanolic extracts of the leaves Annona muricata (AM) and roots of Fagara zanthoxyloide (FZ). Plants samples were collected from Alakahia community, Rivers state and Opoo community, Ogun state; while Wistar albino rats were grouped into normal control, negative control (receiving zidovudine at 100 g/ml/Kg bw), AM and FZ extract treatment (at 4.5 and 3.8 g/ml/Kg B.W respectively) groups with analysis performed bi-weekly. All tests were performed using standard procedures with all reagents of analytic grade. Phytochemical screening of the extracts showed significantly high amounts of alkaloids (10.47- 21.15 mg / 100 g), phenols (10.60-15.22 mg / 100 g) and tannins (14.23 - 50.19 mg / 100 g). The investigation into their proximate compositions also showed high fat (5.78 ± 0.02) in FZ, moisture (10.47 ± 0.05) in AM and fibre (7.37 ± 0.03) in FZ. The amino acid phenylalanine (5.10-6.01 g / 100 g), isoleucine (4.44-5.20 g / 100 g), lysine (4.03 -5.31 g / 100 g) was observed to be available in the extracts. In the normal control group body weight increased by 20.75 g at week 6 while administration of Zidovudine, resulted in a decreased in bodyweight by 1.14 g in week 2 and 3.32 g in week 6. Extract treatment caused a significant increase (p≤0.05) in body weight by 17.95g (AM) and 18.23g (FZ) at week 6. Platelet count was also observed to significantly decrease (p≤0.05) by 33.42% in the negative control group when compared to the normal control. This was observed to significant increases in extract treatment by 49.56% (AM) and 51.32% (FZ). The results thus suggest a possible beneficial effect of the extracts of AM and FZ in checkmating the weight and platelet loss observed as a side effect of zidovudine therapy as well as the possible use in haemorrhagic conditions to reduce bleeding without thromboembolism.

Titrate to equilibrate and not exsanguinate! Characterization and validation of a novel partial resuscitative endovascular balloon occlusion of the aorta catheter in normal and hemorrhagic shock conditions.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a significant advancement in the control of noncompressible truncal hemorrhage. However, its ischemic burden and reperfusion injury following balloon deflation limits its utilization. Partial restoration of aortic flow during REBOA has the potential to balance hemorrhage control and ischemia. This study validates the mechanics, physiology, and optimal partial flow rates using a prototype partial REBOA (pREBOA) device. Twenty-five swine underwent placement of aortic flow probes and zone 1 pREBOA. Experiment 1 (N = 5) animals were not injured and assessed the tested the catheters ability to titrate and control flow. Experiment 2 (N = 10) added 20% hemorrhage and either solid organ, or abdominal vascular injury to compare flow rate and rebleeding from injuries. Experiment 3 (N = 10) swine were similarly prepared, hemorrhaged, and underwent pREBOA at set partial flow rates for 2 hours followed by complete deflation for 30 minutes. Balloon volume at minimum flow (mean, 0.09 L/min) was 3.5 mL to 6.0 mL. Half maximal flow was achieved with 56.5% of maximum balloon inflation. Partial REBOA allowed very fine titration of flow rates. Rebleeding occurred at 0.45 L/min to 0.83 L/min. Distal flow of 0.7 L/min had 50% survival, 0.5 had 100% survival, and 0.3 L had 50% survival with mean end lactates of 9.6, 12.6, and 13.3, respectively. There was a trend toward hyperkalemia and hypocalcemia in nonsurvivors. The pREBOA device demonstrated a high level of titratability for restoration of aortic flow. An optimal partial flow of 0.5 L/min was effective at hemorrhage control while limiting the burden of ischemic injury, and extending the tolerable duration of zone 1 occlusion. Aggressive calcium supplementation prior to and during partial occlusion and reperfusion may be warranted to prevent hyperkalemic arrest.

MP07: Diagnosis of elevated intracranial pressure in critically ill adults – a systematic review and meta-analysis

Introduction: Elevated intracranial pressure (ICP) is a devastating complication of brain injury, such as traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage, ischemic stroke, and other conditions. Delay to diagnosis and treatment are associated with increased morbidity and mortality. For Emergency Department (ED) physicians, invasive ICP measurement is typically not available. We sought to summarize and compare the accuracy of physical examination, imaging, and ultrasonography of the optic nerve sheath diameter (ONSD) for diagnosis of elevated ICP. Methods: We searched Medline, EMBASE and 4 other databases from inception through August 2018. We included only English studies (randomized controlled trials, cohort and case-control studies). Gold standard was ICP≥20 mmHg on invasive ICP monitoring. Two reviewers independently screened studies and extracted data. We assessed risk of bias using Quality Assessment of Diagnostic Accuracy Studies 2 criteria. Hierarchical Summary Receiver Operating Characteristic model generated summary diagnostic accuracy estimates. Results: We included 37 studies (n = 4,768, kappa = 0.96). Of exam signs, pooled sensitivity and specificity for increased ICP were: mydriasis (28.2% [95% CI: 16.0-44.8], 85.9.0% [95% CI: 74.9-92.5]), motor posturing (54.3% [95% CI: 36.6-71.0], 63.6% [95% CI: 46.5-77.8]) and Glasgow Coma Scale (GCS) ≤8 (75.8% [95% CI: 62.4-85.5], 39.9% [95% CI: 26.9-54.5]). Computed tomography findings: compression of basal cisterns had 85.9% [95% CI: 58.0-96.4] sensitivity and 61.0% [95% CI: 29.1-85.6] specificity; any midline shift had 80.9% [95% CI: 64.3-90.9] sensitivity and 42.7% [95% CI: 24.0-63.7] specificity; midline shift≥1cm had 20.7% [95% CI: 13.0-31.3] sensitivity and 89.2% {95% CI: 77.5-95.2] specificity. Finally, pooled area under the ROC curve describing accuracy for ONSD sonography for ICP was 0.94 (95% CI: 0.91-0.96). Conclusion: The absence of any one physical exam feature (e.g. mydriasis, posturing, or decreased GCS) is not sufficient to rule-out elevated ICP. Significant midline shift is highly suggestive of elevated ICP, but absence of shift does not rule it out. ONSD sonography may be useful in diagnosing elevated ICP. High suspicion of elevated ICP may necessitate treatment and transfer to a centre capable of invasive ICP monitoring.

Physiological comparison of hemorrhagic shock and O2max: A conceptual framework for defining the limitation of oxygen delivery.

Disturbance of normal homeostasis occurs when oxygen delivery and energy stores to the body's tissues fail to meet the energy requirement of cells. The work submitted in this review is important because it advances the understanding of inadequate oxygen delivery as it relates to early diagnosis and treatment of circulatory shock and its relationship to disturbance of normal functioning of cellular metabolism in life-threatening conditions of hemorrhage. We explored data from the clinical and exercise literature to construct for the first time a conceptual framework for defining the limitation of inadequate delivery of oxygen by comparing the physiology of hemorrhagic shock caused by severe blood loss to maximal oxygen uptake induced by intense physical exercise. We also provide a translational framework in which understanding the fundamental relationship between the body's reserve to compensate for conditions of inadequate oxygen delivery as a limiting factor to O2max helps to re-evaluate paradigms of triage for improved monitoring of accurate resuscitation in patients suffering from hemorrhagic shock.