Search

Trauma-induced pulmonary thromboembolism is the second leading cause of death in severe trauma patients. Primary fibrinolytic hyperactivity combined with hemorrhage and consequential hypercoagulability in severe trauma patients create a huge challenge for clinicians. It is crucial to ensure a safe anticoagulant therapy for trauma patients, but a series of clinical issues need to be answered first, for example, what are the risk factors for traumatic venous thromboembolism? How to assess and determine the status of coagulation dysfunction of patients? When is the optimal timing to initiate pharmacologic prophylaxis for venous thromboembolism? What types of prophylactic agents should be used? How to manage the anticoagulation-related hemorrhage and to determine the optimal timing of restarting chemoprophylaxis? The present review attempts to answer the above questions.

Objective: To investigate the current practice of extracorporeal cardiopulmonary resuscitation (ECPR) for Chinese cardiac arrest patients after the publication of 2015 American Heart Association guidelines for cardiopulmonary resuscitation. Methods: A questionnaire was distributed to healthcare providers of emergency departments (EDs) and/or Intensive Care Units (ICUs) across 52 hospitals in China from August to November 2016. Data collection ended in February 2017. The questionnaire included three parts: (1) characteristics of the departments and the respondents; (2) knowledge about ECPR; (3) practice of ECPR in cardiac arrest patients (case volume, inclusion/exclusion criteria, ECPR procedure). The characteristics of the departments/hospitals were only answered by the head of the department. Results: A total of 1 952 (86.8%) respondents fulfilled the survey. Only 2.5% of the respondents from 3 of 52 hospitals performed ECPR. Among the three hospitals, the case number of ECPR were ≤5 per year and none of them had written ECPR procedures. Only one hospital had formal inclusion/exclusion criteria. The inclusion criteria included age between 18 to 60 years, suspected cardiogenic cardiac arrest, beginning of cardiopulmonary resuscitation 10 min. The top three reasons for the nonuse of ECPR were unknown fields (31.2%), potential ECMO-related side effects (26.9%) and cost (18.7%). Conclusions: ECPR for cardiac arrest patients are not well understood by healthcare providers in the emergency department or ICUs and its application is still in the early stage in China. Educational training and other interventions are needed to promote the clinical practice.

Many anti-microbial peptides (AMPs) and pro-apoptotic peptides are considered as novel anti-microbial agents, distinguished by their different characteristics. Nevertheless, AMPs exhibit certain limitations, including poor stability and potential toxicity, which hinder their suitability for applications in pharmaceutics and medical devices. In this study, we used recombinant mussel adhesive protein (MAP) as a robust scaffold to overcome these limitations associated with AMPs. Mussel adhesive protein fused with functional peptides (MAP-FPs) was used to evaluate anti-microbial activities, minimal inhibitory concentration (MIC), and time-kill kinetics (TKK) assays against six of bacteria strains. MAP and MAP-FPs were proved to have an anti-microbial effect with MIC of 4 or 8 µM against only Gram-negative bacteria strains. All tested MAP-FPs killed four different Gram-negative bacteria strains within 180 min. Especially, MAP-FP-2 and -5 killed three Gram-negative bacteria strain, including E. coli, S. typhimurium, and K. pneumoniae, within 10 min. A cytotoxicity study using Vero and HEK293T cells indicated the safety of MAP and MAP-FP-2 and -3. Thermal stability of MAP-FP-2 was also validated by HPLC analysis at an accelerated condition for 4 weeks. This study identified that MAP-FPs have novel anti-microbial activity, inhibiting the growth and rapidly killing Gram-negative bacteria strains with high thermal stability and safety.

Objective: To investigate the current practice of extracorporeal cardiopulmonary resuscitation (ECPR) for Chinese cardiac arrest patients after the publication of 2015 American Heart Association guidelines for cardiopulmonary resuscitation. Methods: A questionnaire was distributed to healthcare providers of emergency departments (EDs) and/or Intensive Care Units (ICUs) across 52 hospitals in China from August to November 2016. Data collection ended in February 2017. The questionnaire included three parts: (1) characteristics of the departments and the respondents; (2) knowledge about ECPR; (3) practice of ECPR in cardiac arrest patients (case volume, inclusion/exclusion criteria, ECPR procedure). The characteristics of the departments/hospitals were only answered by the head of the department. Results: A total of 1 952 (86.8%) respondents fulfilled the survey. Only 2.5% of the respondents from 3 of 52 hospitals performed ECPR. Among the three hospitals, the case number of ECPR were ≤5 per year and none of them had written ECPR procedures. Only one hospital had formal inclusion/exclusion criteria. The inclusion criteria included age between 18 to 60 years, suspected cardiogenic cardiac arrest, beginning of cardiopulmonary resuscitation <5 min after cardiac arrest and duration of cardiopulmonary resuscitation >10 min. The top three reasons for the nonuse of ECPR were unknown fields (31.2%), potential ECMO-related side effects (26.9%) and cost (18.7%). Conclusions: ECPR for cardiac arrest patients are not well understood by healthcare providers in the emergency department or ICUs and its application is still in the early stage in China. Educational training and other interventions are needed to promote the clinical practice. [ABSTRACT FROM AUTHOR]