Inflammatory Cytokines Outperform Endotheliopathy Markers as Early Predictors of Mortality in Trauma.

Introduction: Trauma induces cellular injury, coagulopathy, and a dysregulated physiologic response that results from endotheliopathy and the inflammatory response. This study aimed to compare early serum markers of endotheliopathy versus inflammatory cytokines to predict 30-day mortality in critically ill trauma patients.

Methods: Serum samples were collected from 232 trauma patients on admission to the intensive care unit.

Dynamics of Circulating Endothelial Injury Markers Following Kidney Transplantation.

Introduction: Endotheliopathy is well studied in chronic kidney disease, brought on by the chronic stressors of proinflammatory cytokines and reactive oxygen species. However, the endothelial response to renal transplantation has not been well investigated. This study aimed to evaluate circulating biomarkers of endothelial injury acutely after renal transplantation.

A construct validity analysis of the military general surgeon Knowledge, Skills, and Abilities methodology with respect to procedural complexity.

Background: The Knowledge, Skills, and Ability-Clinical Activity (KSA-CA) methodology was developed to gauge surgeon readiness; it uses Current Procedural Terminology codes organized into high- and low-acuity procedural groups. This study will evaluate if the methodology has a measure of procedural complexity.

Methods: Deidentified case logs from 41 general surgery residents (years 1-5) were analyzed.

Importance of social deprivation by neighborhood on the pathway from referral to kidney transplantation.

Background: Despite the known impact of social deprivation on kidney transplant access, no instrument exists that quantifies the likelihood of receiving a transplant using neighborhood-level socioeconomic deprivation.

Methods: Patients referred for kidney transplant evaluation from July 2017 and January 2022 were evaluated. Patients' addresses were geocoded using the DeGAUSS (Decentralized Geomarker Assessment for Multi-Site Studies) system, and deprivation index was generated.

Hypobaric Conditions in Cabin Altitude Restricted Aeromedical Evacuation Induce Systemic Inflammation Following Porcine Traumatic Brain Injury.

Introduction: Secondary injury following traumatic brain injury (TBI) commonly results from hypoxia. Cabin Altitude Restriction (CAR) is used in postinjury aeromedical evacuation (AE) to reduce the hypobaric effects of flight on wounded warriors. Previous work has shown increased inflammation after high altitude exposure following TBI.

Semiautonomous ventilation in a porcine hemorrhage and lung injury model provides lung protective ventilation.

Background: Mechanical ventilation requires frequent reassessment from providers to ensure delivery of lung protective ventilation. However, in resource-limited settings, the time and attention lung protective ventilation requires are not always feasible. This study aimed to compare a physiologic closed-loop control (PCLC) ventilator capable of self-adjusting based on patient parameters against standard of care (SOC) ventilatory management in a porcine model.

A Multi-institutional Study From the US Resident Operative Experience Consortium Examining Factors Associated With Exposure and Pursuit of Colorectal Fellowship After General Surgery Residency.

Background: Colon and rectal surgery is a popular fellowship after general surgery residency. The impact of a resident's colon and rectal surgery experience during residency may impact their career trajectory and pursuit of colon and rectal surgery.

Objective: This study aims to identify individual and program factors associated with matriculation into a colon and rectal surgery fellowship compared to other career trajectories.

Factors affecting the direct red cell effect on thrombosis: Hematocrit dilution and injury patterns.

Background: Red blood cell (RBC) aggregation can be initiated by calcium and tissue factor, which may independently contribute to microvascular and macrovascular thrombosis after injury and transfusion. Previous studies have demonstrated that increased blood storage duration may contribute to thrombotic events. The aims of this study were to first determine the effect of blood product components, age, and hematocrit (HCT) on the aggregability of RBCs, followed by measurement of RBC aggregability in two specific injury models including traumatic brain injury (TBI) and hemorrhagic shock.

Surviving septic patients endotyped with a functional assay demonstrate active immune responses.

Introduction: Sepsis is a complex clinical syndrome characterized by a heterogenous host immune response. Historically, static protein and transcriptomic metrics have been employed to describe the underlying biology. Here, we tested the hypothesis that functional TNF expression as well as an immunologic endotype based on both IFNγ and TNF expression could be used to model clinical outcomes in sepsis patients.

Porcine Packed Red Blood Cells Demonstrate a Distinct Red Blood Cell Storage Lesion.

Introduction: The red blood cell (RBC) storage lesion has been well described in mouse and human blood but not in swine. Understanding the porcine RBC storage lesion is necessary prior to evaluating transfusion of stored packed red blood cells (pRBCs) in polytrauma models. We hypothesized that porcine pRBCs would undergo a similar storage lesion severity after 42 d.

National Landscape of Neoadjuvant Therapy in Potentially Resectable Colon Cancer.

Introduction: Surgery followed by pathology-guided adjuvant therapy is standard treatment for colon cancer. Data from the FOxTROT clinical trial showed potential benefit of a 6-wk neoadjuvant chemotherapy (NACT) in T3/T4 patients. The present study evaluated real-world outcomes of neoadjuvant therapy in a national cohort of patients with resectable colon cancer.

Primary Team Versus Local Recovery in Liver Transplantation in the Modern Era: A National Analysis of the United Network for Organ Sharing Database.

Background: The implementation of acuity circles (AC) in 2020 and the COVID-19 pandemic increased the use of local surgeons to recover livers for transplant; however, the impact on liver transplant (LT) outcomes is unknown.

Methods: Deceased donor adult LT recipients from the UNOS database were identified.  Recipients were grouped by donor surgeon: local versus primary recovery.

External Validation of Predictors of Mortality in Polytrauma Patients.

Introduction: The Parkland Trauma Index of Mortality (PTIM) is an integrated, machine learning 72-h mortality prediction model that automatically extracts and analyzes demographic, laboratory, and physiological data in polytrauma patients. We hypothesized that this validated model would perform equally as well at another level 1 trauma center.

Methods: A retrospective cohort study was performed including ∼5000 adult level 1 trauma activation patients from January 2022 to September 2023.

Multi-Modal Venous ThromboembolicProphylaxis Aids in Risk Reduction Following Splenectomy in Female and Male Mice.

Introduction: Splenectomy (SPLN) is associated with elevated risk of venous thromboembolic (VTE) disease. Enoxaparin (ENX) is a low-molecular-weight heparin agent used in VTE chemoprophylaxis. Early aspirin administration ameliorates postSPLN platelet hyperaggregability in male mice.

Tranexamic Acid Administration Does Not Alter Inflammation After Traumatic Brain Injury, Regardless of Timing.

Introduction: Tranexamic acid (TXA) administered early after traumatic brain injury (TBI) can decrease morbidity and mortality. The purpose of this study is to determine if the timing of TXA administration after TBI affects postinjury inflammatory markers or phosphorylated tau (p-tau) levels within the hippocampus.

Methods: Male mice (9-11 wk) were split into six groups based on injury and timing of TXA administration (n = 5 per group): Sham, TBI-only, 100 mg/kg TXA-only, TBI + TXA 10 min, TBI + TXA 1 h, and TBI + TXA 6 h.

Aberrant Oxygen Concentrations Induce Systemic Inflammation in a Murine Model.

Introduction: Hypoxia is a significant cause of secondary insult in the critically ill trauma or surgical patient. The cause of increased mortality following a brief period of hypoxia is not well understood. The aim of this study is to determine the effect of acute, isolated deviations in oxygen concentration on proinflammatory cytokine release and markers of endothelial stress in a murine model.

Safety and use of late-turndown liver allografts to increase rate of transplantation.

Background: The demand for liver transplants (LT) in the United States far surpasses the availability of allografts. New allocation schemes have resulted in occasional difficulties with allograft placement and increased intraoperative turndowns. We aimed to evaluate the outcomes related to use of late-turndown liver allografts.

Need for Blood Transfusion Volume Is Associated With Increased Mortality in Severe Traumatic Brain Injury.

Introduction: Many patients suffering from isolated severe traumatic brain injury (sTBI) receive blood transfusion on hospital arrival due to hypotension. We hypothesized that increasing blood transfusions in isolated sTBI patients would be associated with an increase in mortality.

Methods: We performed a trauma quality improvement program (TQIP) (2017-2019) and single-center (2013-2021) database review filtering for patients with isolated sTBI (Abbreviated Injury Scale head ≥3 and all other areas ≤2).

Re-evaluating the Use of High Sensitivity Troponin to Diagnose Blunt Cardiac Injury.

Introduction: Blunt cardiac injury (BCI) can be challenging diagnostically, and if misdiagnosed, can lead to life-threatening complications. Our institution previously evaluated BCI screening with troponin and electrocardiogram (EKG) during a transition from troponin I to high sensitivity troponin (hsTnI), a more sensitive troponin I assay. The previous study found an hsTnI of 76 ng/L had the highest capability of accurately diagnosing a clinically significant BCI.

Systemic Inflammatory Effect of Hypobaria During Aeromedical Evacuation after Porcine Traumatic Brain Injury.

Background: Traumatic brain injury (TBI)-related morbidity is caused largely by secondary injury resulting from hypoxia, excessive sympathetic drive, and uncontrolled inflammation. Aeromedical evacuation (AE) is used by the military for transport of wounded soldiers to higher levels of care. We hypothesized that the hypobaric, hypoxic conditions of AE may exacerbate uncontrolled inflammation after TBI that could contribute to more severe TBI-related secondary injury.

Direct red blood cell effect on thrombosis is dependent on the interaction of tissue factor and calcium with membrane phosphatidylserine.

Background: Prior literature has implicated red blood cells (RBCs) in the initiation of thrombosis and suggests that posttransfusion hypercoagulability may occur secondary to the effects of RBCs. Elevated serum tissue factor is a known sequelae of acute trauma. Phosphatidylserine (PS) is a prothrombotic phospholipid present within the RBC cell membrane.

Desmopressin, Misoprostol, nor Carboprost Affect Platelet Aggregability Following Traumatic Brain Injury and Aspirin.

Introduction: Desmopressin (DDAVP) has been utilized clinically in patients taking aspirin (ASA) to improve drug-induced platelet dysfunction. Misoprostol and carboprost, prostaglandin analogs commonly used for postpartum hemorrhage, may also induce platelet aggregation. The aim of this study was to determine the effects of DDAVP, misoprostol, and carboprost administration on platelet aggregability following traumatic brain injury (TBI) in mice treated with ASA.

Just Say NO: Inhaled Nitric Oxide Effect on Respiratory Parameters Following Traumatic Brain Injury in Humans and a Porcine Model.

Introduction: The mechanism of post-traumatic brain injury (TBI) hypoxemia involves ventilation/perfusion mismatch and loss of pulmonary hypoxic vasoconstriction. Inhaled nitric oxide (iNO) has been studied as an adjunct treatment to avoid the use of high positive end-expiratory pressure and inspired oxygen in treatment-refractory hypoxia. We hypothesized that iNO treatment following TBI would improve systemic and cerebral oxygenation via improved matching of pulmonary perfusion and ventilation.

Murine Traumatic Brain Injury Model Comparison: Closed Head Injury Versus Controlled Cortical Impact.

Introduction: Various murine models have been utilized to study TBI, including closed head injury (CHI) and controlled cortical impact (CCI), without direct comparison. The aim of our study was to evaluate these models to determine differences in neurological and behavioral outcomes postinjury.

Methods: Male C57B/6 mice (9-10 wk) were separated into six groups including: untouched, sham craniotomy (4 mm), CCI 0.