A highly porous silica and chitosan-based hemostatic dressing is superior in controlling hemorrhage in a severe groin injury model in swine

Background

This study compared the efficacy of 3 hemostatic dressings in a severe groin injury model in swine.

Methods

Twenty-three swine received TraumaStat (OreMedix, Lebanon, OR), Chitoflex (HemCon, Inc., Portland, OR), or standard gauze for hemostasis. Complete femoral vessel transections were followed by 30 seconds of uncontrolled hemorrhage. The groin was packed with the randomized dressing followed by 30 seconds of compression. Resuscitation with lactated Ringer's solution commenced immediately postcompression to the preinjury mean arterial blood pressure. Hemostasis failure was defined as blood pooling outside the wound. Animals were monitored and maintained at the preinjury mean arterial pressure for 120 minutes, culminating with euthanization.

Results

There were no differences in baseline values between groups. TraumaStat resulted in less hemostasis failure (P < .05), decreased postcompression blood loss (P < .05), and decreased fluid requirement (P < .05). No significant difference in mortality was seen between groups. There were no differences between standard gauze and Chitoflex with respect to dressing failure, posttreatment blood loss, or fluid resuscitation.

Conclusions

TraumaStat performed significantly better than Chitoflex and standard gauze in controlling hemorrhage from a severe groin injury in swine.     

Histological characterization and development of mesial surface sulci in the human brain at 13–15 gestational weeks through high-resolution histology

Cellular-level anatomical data from early fetal brain are sparse yet critical to the understanding of neurodevelopmental disorders. We characterize the organization of the human cerebral cortex between 13 and 15 gestational weeks using high-resolution whole-brain histological data sets complimented with multimodal imaging. We observed the heretofore underrecognized, reproducible presence of infolds on the mesial surface of the cerebral hemispheres. Of note at this stage, when most of the cerebrum is occupied by lateral ventricles and the corpus callosum is incompletely developed, we postulate that these mesial infolds represent the primordial stage of cingulate, callosal, and calcarine sulci, features of mesial cortical development. Our observations are based on the multimodal approach and further include histological three-dimensional reconstruction that highlights the importance of the plane of sectioning. We describe the laminar organization of the developing cortical mantle, including these infolds from the marginal to ventricular zone, with Nissl, hematoxylin and eosin, and glial fibrillary acidic protein (GFAP) immunohistochemistry. Despite the absence of major sulci on the dorsal surface, the boundaries among the orbital, frontal, parietal, and occipital cortex were very well demarcated, primarily by the cytoarchitecture differences in the organization of the subplate (SP) and intermediate zone (IZ) in these locations. The parietal region has the thickest cortical plate (CP), SP, and IZ, whereas the orbital region shows the thinnest CP and reveals an extra cell-sparse layer above the bilaminar SP. The subcortical structures show intensely GFAP-immunolabeled soma, absent in the cerebral mantle. Our findings establish a normative neurodevelopment baseline at the early stage.     

Unusual Clinical Manifestations in a Case of Alagille Syndrome

Alagille syndrome, also known as arteriohepatic dysplasia, is a multisystem autosomal dominant disorder characterized by chronic cholestasis due to a paucity of intrahepatic bile ducts, peripheral pulmonary artery stenosis with associated vertebral, ocular, and renal anomalies, and characteristic facies. We report a case of Alagille syndrome in a 3‐year‐old boy with associated pruritus, follicular keratoses, palmar pits, and keratoderma‐like changes over the dorsum of the hands. There have been single isolated case reports of phrynoderma and keratoderma. Palmar pits have not been reported in the literature.