Identifying the broken heart: predictors of mortality and morbidity in suspected blunt cardiac injury

Background

Blunt cardiac injury (BCI) is an infrequent but potentially fatal finding in thoracic trauma. Its clinical presentation is highly variable and patient characteristics and injury pattern have never been described in trauma patients. The aim of this study was to identify predictors of mortality in BCI patients.

Methods

We performed an 8-year retrospective analysis of all trauma patients diagnosed with BCI at our Level 1 trauma center. Patients older than 18 years, blunt chest trauma, and a suspected diagnosis of BCI were included. BCI was diagnosed based on the presence of electrocardiography (EKG), echocardiography, biochemical cardiac markers, and/or radionuclide imaging studies. Elevated troponin I was defined as more than 2 recordings of greater than or equal to .2. Abnormal EKG findings were defined as the presence of bundle branch block, ST segment, and t-wave abnormalities. Univariate and multivariate regression analyses were performed.

Results

A total of 117 patients with BCI were identified. The mean age was 51 ± 22 years, 65% were male, mean systolic blood pressure was 93 ± 65, and overall mortality rate was 44%. Patients who died were more likely to have a lactate greater than 2.5 (68% vs 31%, P = .02), hypotension (systolic blood pressure < 90) (86% vs 14%, P = .001), and elevated troponin I (86% vs 11%, P = .01). There was no difference in the rib fracture (58% vs 56%, P = .8), sternal fracture (11% vs 21%, P = .2), and abnormal EKG (89% vs 90%, P = .6) findings. Hypotension and lactate greater than 2.5 were the strongest predictors of mortality in BCI.

Conclusions

BCI remains an important diagnostic and management challenge. However, once diagnosed resuscitative therapy focused on correction of hypotension and lactate may prove beneficial. Although the role of troponin in diagnosing BCI remains controversial, elevated troponin may have prognostic significance.     

Accurate Nodal Staging in Pancreatic Cancer in the Era of Neoadjuvant Therapy

World Journal of Surgery - Nodal disease is prognostic in pancreatic ductal adenocarcinoma (PDAC); however, optimal number of examined lymph nodes (ELNs) required to accurately stage nodal disease...     

Clinical trials update from the American College of Cardiology meeting 2010: DOSE,ASPIRE, CONNECT,STICH, STOP‐AF,CABANA, RACE II,EVEREST II,ACCORD, and NAVIGATOR

This article provides information and a commentary on trials relevant to the pathophysiology, prevention and treatment of heart failure presented at the annual meeting of the American College of Cardiology held in March 2010. Unpublished reports should be considered as preliminary, since analyses may change in the final publication. Results from DOSE suggest that giving diuretics using a high‐dose, bolus strategy may be better than using lower doses or a continuous infusion for patients with acute decompensated heart failure. In the ASPIRE study, addition of aliskiren to standard therapy failed to attenuate left ventricular remodelling in post‐MI patients and was associated with more adverse events. In CONNECT, remote monitoring reduced the time from CRT‐D‐ or ICD‐detected events to clinical decision and this was associated with fewer clinic visits and shorter hospitalizations. An analysis from STICH testing the effects of surgical ventricular reconstruction showed no benefit in the sub‐group of patients who achieved a greater reduction in LV volume. STOP‐AF and CABANA did not provide convincing evidence of the effectiveness or safety of catheter ablation for the treatment of AF. RACE II suggests that lenient heart rate control might be as effective as strict rate control in patients with permanent atrial fibrillation. In EVEREST II, a catheter‐based mitral valve repair procedure using the MitraClip® system had similar efficacy to traditional surgery but with fewer short‐term adverse effects. Valsartan reduced progression to diabetes in patients with impaired glucose tolerance but had no effect on cardiovascular events in NAVIGATOR. In ACCORD, strict blood pressure control failed to reduce the risk of overall cardiovascular events in high‐risk diabetic patients.     

Enhancing the sensitivity of a surface plasmon resonance-based optical sensor for zinc ion detection by the modification of a gold thin film

Surface plasmon resonance (SPR) sensors as novel optical sensors for the detection of a variety of analytes have been receiving increasing attention and their sensitivity has become the research hotspot recently. In this study, the sensitivity of an SPR optical sensor was enhanced by modifying a gold thin film with a nanocrystalline cellulose (NCC)-based material for zinc ion (Zn²⁺) detection that exists in the environment due to industrial processing. By replacing the gold thin film with a novel modified-gold thin film, Zn²⁺ can be detected from the range of 0 to 10 ppm using SPR. It is believed that the Zn²⁺ may interact with the negative charge molecules that exist on the modified-gold thin film, and this was confirmed via X-ray photoelectron spectroscopy (XPS). Moreover, this modified-gold-SPR has a high sensitivity of 1.892° ppm⁻¹ up to 0.1 ppm with an enhanced detection of Zn²⁺ as low as 0.01 ppm. The SPR results also followed the Langmuir isotherm model with a binding affinity of 1.927 × 10³ M⁻¹, which further confirmed the sensitivity of the SPR sensor. In addition, using the modified-gold thin film, SPR has a higher affinity towards Zn²⁺ compared to other metal ions, i.e. Ni²⁺, Fe²⁺, Cr²⁺, Mn²⁺, and Co²⁺.

This work focus on sensitivity enhancement of surface plasmon resonance (SPR) optical sensor by modifying the gold thin film with nanocrystalline cellulose (NCC) based material for zinc ion (Zn²⁺) detection.     

Clinical implications of pre-operative rapid BRAF analysis for papillary thyroid cancer

The activating point mutation of the BRAF gene, BRAF(T1799A), is the most common and specific genetic alteration in adult papillary thyroid carcinoma (PTC) and a possible marker of malignant potential of PTC. We have applied the PCR-RFLP method using fine-needle aspiration biopsy samples not only to our clinical practice but also to the international medical assistance effort around the Semipalatinsk Nuclear Testing Site in Kazakhstan. Seventy-seven cases (100 nodules) from Japan and 131 cases (137 nodules) from Kazakhstan were examined. There were 14 Japanese and 76 Kazakhstani cases of cytological malignant tumors from the examined samples. We detected 12 (85.7% of PTC) and 19 (25% of PTC) cases with BRAF(T1799A) among the Japanese and Kazakhstani cases, respectively. Of these cases, we found mutations in one cytologically "suspicious" case and even in two pathologically "benign" cases (after surgery in Kazakhstan). All of the BRAF mutation-positive cases, including those three, were confirmed as PTC by careful pathological examination, including immunohistochemical analysis. In summary, our PCR-RFLP method for BRAF(T1799A) detection using FNAB samples is useful not only for preoperative diagnosis of PTC but also as a complementary diagnostic tool for accurate pathological diagnosis, even after surgery.