Searching for non-invasive markers of tissue hypoxia

Tissue hypoxia is a common end product of circulatory shock and a primary target for resuscitation efforts. In this issue Podbregar and Mozina show that thenar tissue O2 saturation (StO2) and mixed venous O2 saturation (SvO2) co-vary in patients in left ventricular failure, but in patients with sepsis StO2 was higher than SvO2. Although StO2 may co-vary with SvO2 they have different determinants such that after shock StO2 may increase well before SvO2 as a result of increased O2 demands to repay O2 debt incurred during hypoperfusion. Thus, the use of StO2 alone to define the endpoint of resuscitation may be misleading

Editorial

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Promoting and Showcasing Health Informatics in Latin America and the Caribbean through Interdisciplinary Collaboration

ABSTRACT The first Symposium of Health Informatics in Latin America and the Caribbean (SHILAC 2013) took place in Cancun, Mexico on August 14, 2013 as a part of the eleventh LACCEI Latin America and Caribbean Conference for Engineering and Technology (LACCEI 2013). The theme of the event was "Crossing bridges and borders to identify healthcare issues in Latin America and the Caribbean (LAC) and to brainstorm on how health informatics might address these issues in a dynamic environment which values the participation of all of the attendees." The three primary objectives of the event were 1) to showcase health informatics in Latin America and the Caribbean 2) to identify the top health issues in LAC that can best be addressed with health informatics and 3) and to brainstorm and prioritize possible health informatics solutions to those issues. A summary of the key events, an evaluation of the event, as well as an overview of future work are discussed in this paper

WSES SM (World Society of Emergency Surgery Summer Meeting) highlights: emergency surgery around the world (Brazil, Finland, USA)

Emergency surgery is performed in every hospital with a A and E unit all around the world. However it is organized in different ways with different results

Estudio de la etapa de mezclado en el desarrollo de los bioplásticos a base de proteína de guisante

El desarrollo de bioplásticos podría ayudar a combatir el problema medioambiental derivado del uso masivo de plásticos procedentes del petróleo, contribuyendo a la producción de materiales de mayor degradabilidad. Todos los bioplásticos objeto de estudio del presente trabajo poseen una relación proteína/plastificante igual a 60/40. Los bioplásticos se obtuvieron en un proceso que consta de una primera etapa de mezclado, resultando una masa homogénea que fue sometida posteriormente a una segunda etapa de moldeo por inyección. El adecuado control de estas etapas es una parte fundamental en el proceso de elaboración de bioplásticos, por lo que el objetivo principal de este trabajo ha sido explorar la influencia de la velocidad de mezclado sobre las masas y los bioplásticos resultantes. Para ello, se realizó una caracterización de los mismos mediante el estudio de su capacidad de absorción de agua, ensayos mecánicos de tracción, y ensayos reológicos en modo dinámico. Entre los resultados obtenidos, puede destacarse que a bajas velocidades de mezclado resultan masas heterogéneas con variabilidad en sus propiedades.The development of bioplastics could avoid the environmental problem derived from the huge use of petroleum-based plastics and contribute to the production of more degradable materials. In this study, bioplastics have a protein/plasticizer ratio of 60/40 from pea protein and glycerol, respectively. They were manufactured in two stages. Firstly, a mixing stage, in which the resulting dough was use in the second stage, an injection molding. The control of these stages is a fundamental part in the process. The main objective of this work is to explore the influence of the speed of mixing on the dough and bioplastics. The characterization of bioplastics was performed by means of water absorption capacity and rheological dynamic tests. Among the results, it can be highlighted that a heterogeneous dough with variability in their properties appears at low mixing speeds.Plan Propio de la Universidad de Sevilla Proyecto: 2017/00000962Ministerio de Economía, Industria y Competitividad (España) / FEDER, UE CTQ2015-71164

A Dynamic View of Trauma/Hemorrhage-Induced Inflammation in Mice: Principal Drivers and Networks

Background: Complex biological processes such as acute inflammation induced by trauma/hemorrhagic shock/ (T/HS) are dynamic and multi-dimensional. We utilized multiplexing cytokine analysis coupled with data-driven modeling to gain a systems perspective into T/HS. Methodology/Principal Findings: Mice were subjected to surgical cannulation trauma (ST) ± hemorrhagic shock (HS; 25 mmHg), and followed for 1, 2, 3, or 4 h in each case. Serum was assayed for 20 cytokines and NO2-/NO3-. These data were analyzed using four data-driven methods (Hierarchical Clustering Analysis [HCA], multivariate analysis [MA], Principal Component Analysis [PCA], and Dynamic Network Analysis [DyNA]). Using HCA, animals subjected to ST vs. ST + HS could be partially segregated based on inflammatory mediator profiles, despite a large overlap. Based on MA, interleukin [IL]-12p40/p70 (IL-12.total), monokine induced by interferon-γ (CXCL-9) [MIG], and IP-10 were the best discriminators between ST and ST/HS. PCA suggested that the inflammatory mediators found in the three main principal components in animals subjected to ST were IL-6, IL-10, and IL-13, while the three principal components in ST + HS included a large number of cytokines including IL-6, IL-10, keratinocyte-derived cytokine (CXCL-1) [KC], and tumor necrosis factor-α [TNF-α]. DyNA suggested that the circulating mediators produced in response to ST were characterized by a high degree of interconnection/complexity at all time points; the response to ST + HS consisted of different central nodes, and exhibited zero network density over the first 2 h with lesser connectivity vs. ST at all time points. DyNA also helped link the conclusions from MA and PCA, in that central nodes consisting of IP-10 and IL-12 were seen in ST, while MIG and IL-6 were central nodes in ST + HS. Conclusions/Significance: These studies help elucidate the dynamics of T/HS-induced inflammation, complementing other forms of dynamic mechanistic modeling. These methods should be applicable to the analysis of other complex biological processes

Emergency care surveillance and emergency care registries in low-income and middle-income countries: Conceptual challenges and future directions for research

Despite the fact that the 15 leading causes of global deaths and disability-adjusted life years are from conditions amenable to emergency care, and that this burden is highest in low-income and middle-income countries (LMICs), there is a paucity of research on LMIC emergency care to guide policy making, resource allocation and service provision. A literature review of the 550 articles on LMIC emergency care published in the 10-year period from 2007 to 2016 yielded 106 articles for LMIC emergency care surveillance and registry research. Few articles were from established longitudinal surveillance or registries and primarily composed of short-term data collection. Using these articles, a working group was convened by the US National Institutes of Health Fogarty International Center to discuss challenges and potential solutions for established systems to better understand global emergency care in LMICs. The working group focused on potential uses for emergency care surveillance and registry data to improve the quality of services provided to patients. Challenges included a lack of dedicated resources for such research in LMIC settings as well as over-reliance on facility-based data collection without known correlation to the overall burden of emergency conditions in the broader community. The group outlined potential solutions including incorporating data from sources beyond traditional health records, use of standard clinical forms that embed data needed for research and policy making and structured population-based research to establish clear linkages between what is seen in emergency units and the wider community. The group then identified current gaps in LMIC emergency care surveillance and registry research to form a research agenda for the future

Alterations in tissue oxygen saturation measured by near-infrared spectroscopy in trauma patients after initial resuscitation are associated with occult shock

Acord transformatiu CRUE-CSICPurpose: Persistent occult hypoperfusion after initial resuscitation is strongly associated with increased morbidity and mor- tality after severe trauma. The objective of this study was to analyze regional tissue oxygenation, along with other global markers, as potential detectors of occult shock in otherwise hemodynamically stable trauma patients. Methods: Trauma patients undergoing active resuscitation were evaluated 8 h after hospital admission with the measure- ment of several global and local hemodynamic/metabolic parameters. Apparently hemodynamically stable (AHD) patients, defined as having SBP ≥ 90 mmHg, HR < 100 bpm and no vasopressor support, were followed for 48 h, and finally classified according to the need for further treatment for persistent bleeding (defined as requiring additional red blood cell transfusion), initiation of vasopressors and/or bleeding control with surgery and/or angioembolization. Patients were labeled as "Occult shock" (OS) if they required any intervention or "Truly hemodynamically stable" (THD) if they did not. Regional tissue oxygenation (rSO2) was measured non-invasively by near-infrared spectroscopy (NIRS) on the forearm. A vascular occlu- sion test was performed, allowing a 3-min deoxygenation period and a reoxygenation period following occlusion release. Minimal rSO2 (rSO2min), Delta-down (rSO2-rSO2min), maximal rSO2 following cuff-release (rSO2max), and Delta-up (rSO2max-rSO2min) were computed. The NIRS response to the occlusion test was also measured in a control group of healthy volunteers. Results: Sixty-six consecutive trauma patients were included. After 8 h, 17 patients were classified as AHD, of whom five were finally considered to have OS and 12 THD. No hemodynamic, metabolic or coagulopathic differences were observed between the two groups, while NIRS-derived parameters showed statistically significant differences in Delta-down, rSO2min, and Delta-up. Conclusions: After 8 h of care, NIRS evaluation with an occlusion test is helpful for identifying occult shock in apparently hemodynamically stable patients