Methods: A retrospective cohort study of 389 massively transfused trauma patients. Regression methods and the Kruskal-Wallis test were used to test the association between admission platelet count and 24-hour mortality and units of packed red blood cells (PRBCs) transfused.
Results: For every 50 x 10(9)/L increase in admission
platelet count, the odds of death decreased 17% at 6 hours (p = 0.03; 95% confidence selleck screening library interval [CI], 0.70-0.99) and 14% at 24 hours (p = 0.02; 95% CI, 0.75-0.98). The probability of death at 24 hours decreased with increasing platelet count. For every 50 x 10(9)/L increase in platelet count, patients received 0.7 fewer units of blood within the first 6 hours (p = 0.01; 95% CI, -1.3 to -0.14) and one less unit of blood within the first 24 hours (p = 0.002; 95% CI, -1.6 to -0.36). Nirogacestat manufacturer The mean number of units of PRBCs transfused within the first 6 hours and 24 hours decreased with increasing platelet count.
Conclusions: Admission platelet count was inversely correlated with 24-hour mortality and transfusion of PRBCs. A normal platelet count may be insufficient after severe trauma, and as a result, these
patients may benefit from a lower platelet transfusion threshold. Future studies of platelet number and function after injury are needed.”
“Background: The neurally mediated syncope (NMS) is sustained by complex cardiac and vascular reflexes, acting on and amplified by central autonomic loops, resulting in bradycardia and hypotension.
Methods: We evaluated by ultrasound the flow-mediated vasodilation (FMD) and the nitrate-mediated dilation (NMD) in 17 patients with NMS, induced by drug-free tilt test in 6 subjects and by nitrate-potentiated tilt test in the other 11 cases; the syncope was classified as vasodepressive (VD) in 8 cases, cardioinhibitory (CI) in 7, and mixed in 2.
Results: The FMD was not different from controls (10.2 +/- 4.5 vs 11.4 +/- 3.9, P = ns), with normal recovery times; the NMD was greater in fainting subjects than in controls (26.7 +/- 7.3 vs 19.0 +/- 3.6, P < 0.05), with higher values in VD
than in CI syncope Small molecule library nmr (31.1 +/- 7.0 vs 23.1 +/- 5.0, P = ns); compared to controls, subjects with NMS showed normal recovery times after FMD but longer recovery times after nitrate administration (13.0 +/- 5.6 vs 6.3 +/- 0.7 minutes, P < 0.05).
Conclusions: The evaluation of endothelial function supports evidence that NMS is characterized by a marked and sustained endothelial-independent vasodilation, in the presence of a normal FMD; vascular hyperreactivity in response to nitrate administration is particularly overt in vasodepressive syncope and can explain the high rate of responses to nitrate administration during tilt test.”
“Aims: We evaluated a putative central inhibitory effect of intravesical botulinum toxin A (BoNT-A) on the activity of lumbosacral spinal neurons in a chronic spinal cord injury (SCI) model of bladder overactivity.