Blue Light as an Anti-inflammatory and Analgesic Strategy in Thoracic Trauma (BLAASTT): protocol for a randomised controlled trial in adult trauma inpatients with painful rib fractures.

Introduction: Blue light (peak wavelength 442 nm) has been shown to modulate the immune response in preclinical models of intra-abdominal sepsis and pneumonia. pathways involve optic nerve stimulation with transmission to the central nervous system, activation of parasympathetic pathways terminating at the spleen, and downstream immune effects including decreased inflammatory tissue damage and improved pathogen clearance. Related effects on pain mediators including proinflammatory cytokines (interleukin 6, TNF- α) and autonomic tone (increased parasympathetic outflow) suggest possible analgesic properties that would be highly relevant to a trauma population.

ECMO-induced coagulopathy: strategic initiatives for research and clinical practice (a workshop report of the NHLBI).

In May 2024, the Division of Blood Diseases and Resources of the National Heart, Lung, and Blood Institute (NHLBI) hosted a hybrid workshop on "Extracorporeal membrane oxygenation (ECMO)-induced coagulopathy: strategic initiatives for research and clinical practice." The event brought together clinicians, scientists, bioengineers, and policymakers to address the challenges of ECMO-associated coagulopathy and explore novel therapeutic approaches. Through expert presentations and collaborative discussions, the workshop focused on innovative anticoagulation strategies, precision medicine, and advanced diagnostics to enhance patient care.

Targeting hemostatic enzymes: from mechanistic insights to therapeutic frontiers.

Purpose Of Review: This review examines the enzymatic regulation of coagulation and fibrinolysis, focusing on key players such as thrombin, plasmin, and ADAMTS13. We highlight how dysregulation of these enzymes contributes to thrombotic and hemorrhagic disorders and review emerging diagnostic biomarkers and therapeutic strategies.

Recent Findings: Recent studies demonstrate the prognostic utility of biomarkers such as thrombin-antithrombin (TAT) and plasmin-α2-antiplasmin (PAP) complexes across critical illnesses including trauma, sepsis, and stroke.

Therapeutic-dose heparin combined with antiplatelets in noncritically ill patients with COVID-19: a secondary analysis of a multiplatform randomized controlled trial.

Background: Therapeutic-dose heparin improves outcomes in noncritically ill patients hospitalized for COVID-19. The effect of antiplatelet exposure in addition to therapeutic-dose heparin is unknown.

Objectives: To evaluate the effect of antiplatelet exposure in addition to therapeutic-dose heparin on survival without organ support.

Strategies to Promote Resiliency: A Randomized Embedded Multifactorial Adaptative Platform (REMAP) Clinical Trial to Study Interventions to Improve Recovery After Surgery in High-Risk Patients.

Objective: In a randomized, embedded, multifactorial, adaptive platform (REMAP) trial, we hypothesized that perioperative metformin would improve postoperative time alive and out of the hospital, defined by 90-day hospital-free days (HFD-90), among nondiabetic aged adults.

Background: As our population ages, patients are increasingly frail requiring an emphasis on treatments to counteract their diminished resilience, especially following the stress of surgery. Growing literature supports metformin as an antiaging and anti-inflammatory therapy with beneficial effects extending into the perioperative period.

Examining air medical transport in interfacility emergency general surgery transfers to a quaternary center.

Background: Regionalized care has increased interfacility transfers, particularly for emergency general surgery (EGS) patients requiring urgent, specialized care. Air medical transport (AMT) provides rapid transfer with critical care capabilities and is increasingly used for EGS, but its time-saving benefits remain uncertain. This study aims to identify the population of EGS patients undergoing AMT and the distance thresholds where AMT is faster than ground transport.

Gasdermin D drives the systemic storm and mortality after trauma with hemorrhage to a greater degree in biological females than males.

Severe injury accompanied by hemorrhagic shock triggers an early release of cell constituents into the circulation, referred to as the systemic storm. The systemic storm drives the systemic inflammatory response and is associated with increased mortality. The role of programmed cell death (PCD) in the systemic storm was investigated in mice that underwent hemorrhagic shock with tissue trauma (HS/T) followed by crystalloid resuscitation.

Platelet flux in trauma-associated venous thromboembolism: A secondary analysis of the Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT) studies.

Background: Venous thromboembolism (VTE) after traumatic injury is morbid. Evaluating changes in platelets in injured patients who develop VTE could identify platelet-based strategies for management of thrombotic complications after injury.

Methods: In a prospectively designed secondary analysis of a multicenter cohort study conducted by the Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT1) study group, injured patients aged 18 to 40 years admitted for a minimum of 48 hours with at least one risk factor for VTE were evaluated.

High-dimensional analysis of injured patients reveals distinct circulating proteomic profiles in plasma vs. whole blood resuscitation.

Early blood product resuscitation is often essential for optimal trauma care. However, the effects of different products on the underlying trauma-induced coagulopathy and immune dysfunction are not well described. Here, we use high-dimensional analysis and causal modeling in a longitudinal study to explore the circulating proteomic response to plasma as a distinct component versus low-titer O whole blood (LTOWB), which contains plasma.

Machine Learning Predicts Bleeding Risk in Atrial Fibrillation Patients on Direct Oral Anticoagulant.

Predicting major bleeding in nonvalvular atrial fibrillation (AF) patients on direct oral anticoagulants (DOACs) is crucial for personalized care. Alternatives like left atrial appendage closure devices lower stroke risk with fewer nonprocedural bleeds. This study compares machine learning (ML) models with conventional bleeding risk scores (HAS-BLED, ORBIT, and ATRIA) for predicting bleeding events requiring hospitalization in AF patients on DOACs at their index cardiologist visit.

Health Equity and Emergency Colorectal Surgery in the United States: A Scoping Review.

Introduction: The emergency colorectal surgery population represents one of the most vulnerable subsets of the larger emergency general surgery population, characterized by increased complication rates, mortality rates, health resource utilization, and hospitalization costs. Disparities and inequities are documented for the emergency general surgery population and its emergency colorectal subset. Addressing health inequities can lead to decreased costs and improvement in patient outcomes; however, it is important to have a full scope of drivers of health inequities in different populations.

Predictive value of platelet function assays in traumatic brain injury patients on antiplatelet therapy.

Introduction: Traumatic brain injury (TBI) patients on antiplatelet therapy face higher mortality because of impaired platelet function, which may be treated by platelet transfusion. The value of testing platelet function in this cohort remains controversial. We aimed to evaluate the relationship between platelet function assays and outcomes in TBI patients on antiplatelet therapy receiving platelet transfusions.

A Randomized Controlled Trial of Sublingual Sufentanil in Early Management of Pain in Trauma.

Background: Pain management is essential in trauma. Sufentanil is a potent sublingual opioid analgesic with no active metabolites and rapid onset relative to oral medications. We hypothesize that compared to standard care, Sufentanil reduces the verbally administered numerical pain scale (VNRS) at 30 minutes.

Early achievement of hemostasis defined by transfusion velocity: A possible mechanism for whole blood survival benefit.

Introduction: Whole blood resuscitation is associated with survival benefits in observational cohort studies. The mechanisms responsible for outcome benefits have not been adequately determined. We sought to characterize the achievement of hemostasis across patients receiving early whole blood versus component resuscitation.

High-grade liver injury: outcomes with a trauma surgery-liver surgery collaborative approach.

Background: Operative mortality for high-grade liver injury (HGLI) remains 42% to 66%, with near-universal mortality after retrohepatic caval injury. The objective of this study was to evaluate mortality and complications of operative and nonoperative management (OM and NOM) of HGLI at our institution, characterized by a trauma surgery-liver surgery collaborative approach to trauma care.

Methods: This was an observational cohort study of adult patients (age ≥16) with HGLI (The American Association for Surgery of Trauma (AAST) grades IV and V) admitted to an urban level I trauma center from January 2010 to November 2021.

Early Cold-stored Platelet Transfusion following Traumatic Brain Injury: A Randomized Clinical Trial.

Objective: To determine the feasibility, efficacy, and safety of cold storage compared with room temperature (RT) platelet transfusion in patients with traumatic brain injury (TBI).

Background: Data demonstrating the safety and efficacy of cold-stored platelet (CSP) transfusion are lacking after TBI.

Methods: A phase 2, randomized, open-label clinical trial was performed at a single U.

Anticoagulation Among Patients Hospitalized for COVID-19 : A Systematic Review and Prospective Meta-analysis.

Background: Reported results of clinical trials assessing higher-dose anticoagulation in patients hospitalized for COVID-19 have been inconsistent.

Purpose: To estimate the association of higher- versus lower-dose anticoagulation with clinical outcomes.

Data Sources: Randomized trials were identified from the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.

Microfluidics in Assessing Platelet Function.

Microfluidics incorporate physiologically relevant substrates and flows that mimic the vasculature and are, therefore, a valuable tool for studying aspects of thrombosis and hemostasis. At high-shear environments simulating arterial flow, a microfluidic assay facilitates the study of platelet function, as platelet-rich thrombi form in a localized stenotic region of a flow channel. Utilizing devices that allow for small sample volume can additionally aid in evaluating platelet function under flow from volume-limited patient samples or animal models.

A surface-functionalized whole blood-based dielectric microsensor for assessment of clot firmness in a fibrinolytic environment.

Accurate assessment of fibrin clot stability can predict bleeding risk in coagulopathic conditions such as thrombocytopenia and hypofibrinogenemia. Hyperfibrinolysis - a clinical phenotype characterized by an accelerated breakdown of the fibrin clot - makes such assessments challenging by obfuscating the effect of hemostatic components including platelets or fibrinogen on clot stability. In this work, we present a biofunctionalized, microfluidic, label-free, electronic biosensor to elicit unique, specific, and differential responses from the multifactorial processes of blood coagulation and fibrinolysis ex vivo.

Alterations in visible light exposure modulate platelet function and regulate thrombus formation.

Background: Variations in light exposure are associated with changes in inflammation and coagulation. The impact of light spectra on venous thrombosis (VT) and arterial thrombosis is largely unexplored.

Objectives: To investigate the impact of altering light spectrum on platelet function in thrombosis.

Sodium-glucose co-transporter-2 inhibitors for hospitalised patients with COVID-19: a prospective meta-analysis of randomised trials.

Background: Sodium-glucose co-transporter-2 (SGLT2) inhibitors have been proposed as a potential treatment for adults hospitalised with COVID-19, due to their potential anti-inflammatory and endothelial protective effects. Published evidence from randomised control trials (RCTs) does not provide evidence of benefit. We aimed to estimate the effect of oral administration of SGLT2 inhibitors compared with usual care or placebo in adults hospitalised with COVID-19.

Effect of sodium-glucose co-transporter-2 inhibitors on survival free of organ support in patients hospitalised for COVID-19 (ACTIV-4a): a pragmatic, multicentre, open-label, randomised, controlled, platform trial.

Background: Patients hospitalised for COVID-19 are at risk for multiorgan failure and death. Sodium-glucose co-transporter-2 (SGLT2) inhibitors provide cardiovascular and kidney protection in patients with cardiometabolic conditions and could provide organ protection during COVID-19. We aimed to investigate whether SGLT2 inhibitors can reduce the need for organ support in patients hospitalised for COVID-19.