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[PMID]: 25661741
[Au] Autor:Sobotka S; Mu L
[Ad] Address:Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York. Electronic address: stanislaw.sobotka@mountsinai.org.
[Ti] Title:Muscle reinnervation with nerve-muscle-endplate band grafting technique: correlation between force recovery and axonal regeneration.
[So] Source:J Surg Res;195(1):144-51, 2015 May 1.
[Is] ISSN:1095-8673
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: This study was designed to determine the correlation between functional recovery and the extent of axonal regeneration after muscle reinnervation with our recently developed nerve-muscle-endplate band grafting (NMEG) technique in a rat model. MATERIALS AND METHODS: The right experimentally paralyzed sternomastoid (SM) muscle by nerve transection was immediately reinnervated with an NMEG pedicle harvested from a neighboring sternohyoid muscle. The NMEG pedicle contained a muscle block (6 × 6 × 3 mm), a donor nerve branch with nerve terminals, and a motor endplate band. Three months after surgery, the tetanic force of the SM muscle was measured and the regenerated axons in the muscle were detected using neurofilament immunohistochemistry. RESULTS: The results showed that the maximal tetanic force (a measure of muscle functional recovery) of the NMEG-reinnervated SM muscle reached up to 66.0% of the normal control. The wet weight of the reinnervated SM muscle (a measure of muscle mass recovery) was 87.2% of the control. The area fraction of the regenerating axons visualized with neurofilament staining within the NMEG-reinnervated SM muscle (a measure of muscle reinnervation) was 42.3%. A positive correlation was revealed between the extent of muscle reinnervation and maximal muscle force. CONCLUSIONS: Our newly developed NMEG technique results in satisfactory functional outcomes and nerve regeneration. Further improvement in the functional recovery after NMEG reinnervation could be achieved by refining the surgical procedure and creating an ideal environment that favors axon-endplate connections and accelerates axonal growth and sprouting.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1504
[Cu] Class update date: 150404
[Lr] Last revision date:150404
[Js] Journal subset:IM
[St] Status:In-Data-Review

  2 / 1445543 MEDLINE  
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[PMID]: 25840079
[Au] Autor:Kotagal M; Richards MK; Flum DR; Acierno SP; Weinsheimer RL; Goldin AB
[Ad] Address:Department of Surgery, University of Washington, Seattle, WA, USA; Surgical Outcomes Research Center (SORCE), University of Washington, Seattle, WA, USA; CHASE Alliance, University of Washington, Seattle, WA, USA. Electronic address: mkotagal@uw.edu....
[Ti] Title:Use and accuracy of diagnostic imaging in the evaluation of pediatric appendicitis.
[So] Source:J Pediatr Surg;50(4):642-6, 2015 Apr.
[Is] ISSN:1531-5037
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: There are safety concerns about the use of radiation-based imaging (computed tomography [CT]) to diagnose appendicitis in children. Factors associated with CT use remain to be determined. METHODS: For patients ≤18years old undergoing appendectomy, we evaluated diagnostic imaging performed, patient characteristics, hospital type, and imaging/pathology concordance (2008-2012) using data from Washington State's Surgical Care and Outcomes Assessment Program. RESULTS: Among 2538 children, 99.7% underwent pre-operative imaging. 52.7% had a CT scan as their first study. After adjustment, age >10years (OR 2.9 (95% CI 2.2-4.0), Hispanic ethnicity (OR 1.7, 95% CI 1.5-1.9), and being obese (OR 1.7, 95% CI 1.4-2.1) were associated with CT use first. Evaluation at a non-children's hospital was associated with higher odds of CT use (OR 7.9, 95% CI 7.5-8.4). Ultrasound concordance with pathology was higher for males (72.3 vs. 66.4%, p=.03), in perforated appendicitis (75.9 vs. 67.5%, p=.009), and at children's hospitals compared to general adult hospitals (77.3 vs. 62.2%, p<.001). CT use has decreased yearly statewide. CONCLUSIONS: Over 50% of children with appendicitis had radiation-based imaging. Understanding factors associated with CT use should allow for more specific QI interventions to reduce radiation exposure. Site of care remains a significant factor in radiation exposure for children.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1504
[Cu] Class update date: 150404
[Lr] Last revision date:150404
[Js] Journal subset:IM
[St] Status:In-Data-Review

  3 / 1445543 MEDLINE  
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[PMID]: 25747165
[Au] Autor:Zhang C; Bald M; Tang M; Li Y; Huang D
[Ad] Address:From the Center for Ophthalmic Optics & Lasers (Zhang, Bald, Tang, Li, Huang), Casey Eye Institute and Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA; the Southwest Eye Hospital (Zhang), Third Military Medical University, Chongqing, China....
[Ti] Title:Interface quality of different corneal lamellar-cut depths for femtosecond laser-assisted lamellar anterior keratoplasty.
[So] Source:J Cataract Refract Surg;41(4):827-35, 2015 Apr.
[Is] ISSN:1873-4502
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: To evaluate the interface quality of different corneal lamellar-cut depths with the femtosecond laser and determine a feasible range of depth for femtosecond laser-assisted lamellar anterior keratoplasty. SETTING: Casey Eye Institute, Portland, Oregon, USA. DESIGN: Experimental study. METHODS: Full lamellar cuts were made on 20 deepithelialized human cadaver corneas using the femtosecond laser. The cut depth was 17% to 21% (100 µm), 31%, 35%, 38% to 40%, and 45% to 48% of the central stromal thickness. Scanning electron microscopy images of the cap and bed surfaces were subjectively graded for ridge and roughness using a scale of 1 to 5 (1 = best). The graft-host match was evaluated by photography and optical coherence tomography in a simulated procedure. RESULTS: The ridge score was correlated with the cut depth (P = .0078, R = 0.58) and better correlated with the percentage cut depth (P = .00024, R = 0.73). The shallowest cuts had the fewest ridges (score 1.25). The 31% cut depth produced significantly fewer ridges (score 2.15) than deeper cuts. The roughness score ranged from 2.19 to 3.08 for various depths. A simulated procedure using a 100 µm host cut and a 177 µm (31%) graft had a smooth interface and flush anterior junction using an inverted side-cut design. CONCLUSIONS: The femtosecond laser produced more ridges in deeper lamellar cuts. A depth setting of 31% stromal thickness might produce adequate surface quality for femtosecond laser-assisted lamellar anterior keratoplasty. The inverted side-cut design produced good edge apposition even when the graft was thicker than the host lamellar-cut depth. FINANCIAL DISCLOSURE: Proprietary or commercial disclosures are listed after the references.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1504
[Cu] Class update date: 150404
[Lr] Last revision date:150404
[Js] Journal subset:IM
[St] Status:In-Data-Review

  4 / 1445543 MEDLINE  
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[PMID]: 25690999
[Au] Autor:Obase K; Jeevanandam V; Saito K; Kesner K; Barry A; Hollatz A; Farooqui F; Addetia K; Roberts JD; Ota T; Balkhy HH; Yoshida K; Mor-Avi V; Lang RM
[Ad] Address:Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois; Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan. Electronic address: kikuko_obase@hotmail.com....
[Ti] Title:Visualization and measurement of mitral valve chordae tendineae using three-dimensional transesophageal echocardiography from the transgastric approach.
[So] Source:J Am Soc Echocardiogr;28(4):449-54, 2015 Apr.
[Is] ISSN:1097-6795
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: The evaluation of the submitral apparatus is challenging from the conventional transesophageal approach. The aim of this study was to test the feasibility of using three-dimensional (3D) transesophageal echocardiographic (TEE) imaging from the transgastric approach to visualize the submitral apparatus and quantify the lengths of the chordae tendineae by using multiplanar reconstruction analysis. METHODS: Twenty-two patients who had transgastric full-volume 3D TEE data sets before mitral valve surgery underwent surgical measurement of chordal length. A short-axis plane at the chordal level was extracted from the 3D data set to identify leaflet segments and the corresponding primary chords. Then, for each chord, the optimal plane was selected to visualize and measure the entire chordal length from its origin at the leaflet margin to the papillary muscle tips. Measurements were performed at the phase of the cardiac cycle when chordal length reached its maximum. Measured values were compared with surgical measurements using linear regression and Bland-Altman analyses. RESULT: One hundred forty-six primary chords were measured intraoperatively. Three-dimensional TEE imaging was able to measure the lengths of all these chords. The surgical and 3D TEE measurements (mean, 1.96 ± 0.56 vs 1.93 ± 0.50 cm, respectively) correlated highly (r = 0.93, P < .0001), with a minimal bias of 0.03 cm and narrow limits of agreement from -0.39 to 0.45 cm. CONCLUSION: Transgastric 3D TEE imaging of the submitral apparatus allows visualization and accurate measurement of chordae tendineae lengths, which may be useful for planning mitral valve repair, including percutaneous transcatheter procedures.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1504
[Cu] Class update date: 150404
[Lr] Last revision date:150404
[Js] Journal subset:IM
[St] Status:In-Data-Review

  5 / 1445543 MEDLINE  
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[PMID]: 25607758
[Au] Autor:Ghaferi AA; Dimick JB
[Ad] Address:*Center for Healthcare Outcomes and Policy and the Department of Surgery, University of Michigan, Ann Arbor, MI †Ann Arbor Veterans Affairs Hospital, Ann Arbor, MI.
[Ti] Title:Understanding failure to rescue and improving safety culture.
[So] Source:Ann Surg;261(5):839-40, 2015 May.
[Is] ISSN:1528-1140
[Cp] Country of publication:United States
[La] Language:eng
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1504
[Cu] Class update date: 150404
[Lr] Last revision date:150404
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1097/SLA.0000000000001135

  6 / 1445543 MEDLINE  
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[PMID]: 25185469
[Au] Autor:Singh P; Aggarwal R; Tahir M; Pucher PH; Darzi A
[Ad] Address:*Division of Surgery, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, United Kingdom †Perelman School of Medicine, University of Pennsylvania, Philadelphia. Presented at the Seventh Annual Meeting of the Consortium of the American College of Surgeons--Accredited Education Institutes, March 21-22, 2014, Chicago, IL.
[Ti] Title:A Randomized Controlled Study to Evaluate the Role of Video-based Coaching in Training Laparoscopic Skills.
[So] Source:Ann Surg;261(5):862-9, 2015 May.
[Is] ISSN:1528-1140
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: This study evaluates whether video-based coaching can enhance laparoscopic surgical skills performance. BACKGROUND: Many professions utilize coaching to improve performance. The sports industry employs video analysis to maximize improvement from every performance. METHODS: Laparoscopic novices were baseline tested and then trained on a validated virtual reality (VR) laparoscopic cholecystectomy (LC) curriculum. After competence, subjects were randomized on a 1:1 ratio and each performed 5 VRLCs. After each LC, intervention group subjects received video-based coaching by a surgeon, utilizing an adaptation of the GROW (Goals, Reality, Options, Wrap-up) coaching model. Control subjects viewed online surgical lectures. All subjects then performed 2 porcine LCs. Performance was assessed by blinded video review using validated global rating scales. RESULTS: Twenty subjects were recruited. No significant differences were observed between groups in baseline performance and in VRLC1. For each subsequent repetition, intervention subjects significantly outperformed controls on all global rating scales. Interventions outperformed controls in porcine LC1 [Global Operative Assessment of Laparoscopic Skills: (20.5 vs 15.5; P = 0.011), Objective Structured Assessment of Technical Skills: (21.5vs 14.5; P = 0.001), and Operative Performance Rating System: (26 vs 19.5; P = 0.001)] and porcine LC2 [Global Operative Assessment of Laparoscopic Skills: (28 vs 17.5; P = 0.005), Objective Structured Assessment of Technical Skills: (30 vs 16.5; P < 0.001), and Operative Performance Rating System: (36 vs 21; P = 0.004)]. Intervention subjects took significantly longer than controls in porcine LC1 (2920 vs 2004 seconds; P = 0.009) and LC2 (2297 vs 1683; P = 0.003). CONCLUSIONS: Despite equivalent exposure to practical laparoscopic skills training, video-based coaching enhanced the quality of laparoscopic surgical performance on both VR and porcine LCs, although at the expense of increased time. Video-based coaching is a feasible method of maximizing performance enhancement from every clinical exposure.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1504
[Cu] Class update date: 150404
[Lr] Last revision date:150404
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1097/SLA.0000000000000857

  7 / 1445543 MEDLINE  
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[PMID]: 24950285
[Au] Autor:Zhao G; Yu YM; Kaneki M; Bonab AA; Tompkins RG; Fischman AJ
[Ad] Address:From the Surgical Service, Massachusetts General Hospital, Shriners Hospitals for Children, and Harvard Medical School, Boston, MA.
[Ti] Title:Simvastatin Reduces Burn Injury-induced Splenic Apoptosis via Downregulation of the TNF-α/NF-κB Pathway.
[So] Source:Ann Surg;261(5):1006-12, 2015 May.
[Is] ISSN:1528-1140
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: Recent studies have suggested that epidermal burn injuries are associated with inflammation and immune dysfunction. Simvastatin has been shown to possess potent anti-inflammatory properties. Thus, we hypothesized that simvastatin protects against burn-induced apoptosis in the spleen via its anti-inflammatory activity. METHODS: Wild-type, tumor necrosis factor alpha knockout (TNF-α KO) and NF-κB KO mice were subjected to full-thickness burn injury or sham treatment. The mice then were treated with or without simvastatin, and the spleen was harvested to measure the extent of apoptosis. Expression levels of TNF-α and NF-κB were also determined in spleen tissue and serum. RESULTS: Burn injury induced significant splenic apoptosis and systemic cytokine production. Simvastatin protected the spleen from apoptosis, reduced cytokine production in the serum, and increased the survival rate. Simvastatin decreased burn-induced TNF-α and NF-κB expression in the spleen and serum. TNF-α and NF-κB KO mice demonstrated lower levels of apoptosis in spleen in response to burn injury. Simvastatin did not further decrease burn-caused apoptosis and mortality in either strain of KO mice. CONCLUSIONS: Simvastatin reduces burn-induced splenic apoptosis via downregulation of the TNF-α/NF-κB pathway.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1504
[Cu] Class update date: 150404
[Lr] Last revision date:150404
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1097/SLA.0000000000000764

  8 / 1445543 MEDLINE  
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[PMID]: 24950261
[Au] Autor:Chang ST; Nguyen DC; Raptis C; Menias CO; Zhou G; Wang-Gillam A; Linehan DC; Hawkins WG; Strasberg SM; Fields RC
[Ad] Address:*Department of Radiology †Department of Surgery ‡Division of Public Health Sciences; and §Division of Medical Oncology, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO; and ¶Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO.
[Ti] Title:Natural history of preoperative subcentimeter pulmonary nodules in patients with resectable pancreatic adenocarcinoma: a retrospective cohort study.
[So] Source:Ann Surg;261(5):970-5, 2015 May.
[Is] ISSN:1528-1140
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To determine the detection rate, radiologic characteristics, and natural history of incidental subcentimeter pulmonary nodules (SCPN) among patients with resectable pancreatic adenocarcinoma and to clarify whether further preoperative evaluation should be considered. BACKGROUND: The clinical significance of SCPN detected by routine preoperative abdominal imaging in patients with pancreatic adenocarcinoma is unknown. METHODS: Patients who underwent resection for pancreatic adenocarcinoma between 2000 and 2010 were queried from a prospectively maintained database at a single institution. Pre- and postoperative computed tomographic (CT) imaging was independently reviewed and the presence and radiologic features of SCPNs were analyzed for associations with overall survival (OS). RESULTS: Of the 463 patients who met inclusion criteria, 329 (71%) had reviewable preoperative imaging. Preoperative SCPNs were described in 59 patients (18%), and 41 patients had follow-up imaging available for review. Only increasing age (67.1 vs 63.5 years; P = 0.005) was associated with the presence of SCPN. Six patients (1.8%) had new or enlarging nodules after surgery, of whom 5 (1.5%) had confirmed metastatic adenocarcinoma. There was no difference in OS between patients with or without preoperative SCPN (16.1 vs 19.1 months; P = 0.201). No radiographic criterion of SCPN (including number, size, laterality, calcification, or contour) was associated with OS. CONCLUSIONS: Neither the presence of preoperative SCPN nor nodule characteristics was associated with OS among patients who underwent pancreaticoduodenectomy (PD) for pancreatic cancer. These data do not support routine additional workup of preoperative SCPN in patients with resectable pancreatic adenocarcinoma.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1504
[Cu] Class update date: 150404
[Lr] Last revision date:150404
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1097/SLA.0000000000000719

  9 / 1445543 MEDLINE  
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[PMID]: 24887972
[Au] Autor:Johnston M; Arora S; Anderson O; King D; Behar N; Darzi A
[Ad] Address:*Centre for Patient Safety and †Centre for Health Policy, Department of Surgery and Cancer, Imperial College London; and ‡Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
[Ti] Title:Escalation of care in surgery: a systematic risk assessment to prevent avoidable harm in hospitalized patients.
[So] Source:Ann Surg;261(5):831-8, 2015 May.
[Is] ISSN:1528-1140
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To systematically risk assess and analyze the escalation of care process in surgery so as to identify problems and provide recommendations for intervention. BACKGROUND: The ability to escalate care appropriately when managing deteriorating patients is a hallmark of surgical competence and safe postoperative care. Healthcare-Failure-Mode-Effects-Analysis (HFMEA) is a methodology adapted from safety-critical industries, which allows for hazardous process failures to be prospectively identified and solutions to be recommended. METHODS: Forty-two hours of ethnographic observations on surgical wards in 3 London hospitals (phase 1) formed the basis of an escalation process diagram. A risk-assessment survey identified failures associated with process steps and attributed hazard scores (phase 2). Patient safety and clinical risk experts validated hazard scores through a group consensus meeting (phase 3). Hazardous failures were taken forward to multidisciplinary HFMEA where cause analysis was applied and interventions were recommended (phase 4). RESULTS: Observations identified 33 steps in the escalation process. The risk-assessment survey (30 surgical staff members, 100% response) and expert consensus group identified 18 hazardous failures associated with these steps. The HFMEA team identified 3 adequately controlled failures; therefore, 15 were subjected to cause analysis. Outdated communication technology, understaffing, and hierarchical barriers were identified as root causes of failure. Participants recommended interventions based on these findings including defined escalation protocols, human factors education, enhanced communication technology, and improved clinical supervision. CONCLUSIONS: Failures in the escalation process amenable to intervention were systematically identified. This mapping of the escalation process will allow tailored interventions to enhance surgical training and patient safety.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1504
[Cu] Class update date: 150404
[Lr] Last revision date:150404
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1097/SLA.0000000000000762

  10 / 1445543 MEDLINE  
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[PMID]: 24670858
[Au] Autor:Brown JB; Cohen MJ; Minei JP; Maier RV; West MA; Billiar TR; Peitzman AB; Moore EE; Cuschieri J; Sperry JL; Inflammation and the Host Response to Injury Investigators
[Ad] Address:*Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA †Department of Surgery, University of California, San Francisco, CA ‡Division of Burn, Trauma, Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX §Division of General Surgery and Trauma, Harborview Medical Center, and the Department of Surgery, University of Washington, Seattle, WA; and ‖Department of Surgery, Denver Health Medical Center, and The University of Colorado Health Sciences Center, Denver, CO.
[Ti] Title:Pretrauma center red blood cell transfusion is associated with reduced mortality and coagulopathy in severely injured patients with blunt trauma.
[So] Source:Ann Surg;261(5):997-1005, 2015 May.
[Is] ISSN:1528-1140
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To evaluate the association of pretrauma center (PTC) red blood cell (RBC) transfusion with outcomes in severely injured patients. BACKGROUND: Hemorrhage remains a major driver of mortality. Little evidence exists supporting PTC interventions to mitigate this. METHODS: Blunt injured patients in shock arriving at a trauma center within 2 hours of injury were included from the Glue Grant database. Subjects were dichotomized by PTC RBC transfusion. Outcomes included 24-hour mortality, 30-day mortality, and trauma-induced coagulopathy [(TIC), admission international normalized ratio >1.5]. Cox regression and logistic regression determined the association of PTC RBC transfusion with outcomes. To address baseline differences, propensity score matching was used. RESULTS: Of 1415 subjects, 50 received PTC RBC transfusion. Demographics and injury severity score were similar. The PTC RBC group received 1.3 units of RBCs (median), and 52% were scene transports. PTC RBC transfusion was associated with a 95% reduction in odds of 24-hour mortality [odds ratio (OR) = 0.05; 95% confidence interval (CI), 0.01-0.48; P < 0.01], 64% reduction in the risk of 30-day mortality [hazard ratio = 0.36; 95% CI, 0.15-0.83; P = 0.02], and 88% reduction in odds of TIC (OR = 0.12; 95% CI, 0.02-0.79; P = 0.03). The matched cohort included 113 subjects (31% PTC RBC group). Baseline characteristics were similar. PTC RBC transfusion was associated with a 98% reduction in odds of 24-hour mortality (OR = 0.02; 95% CI, 0.01-0.69; P = 0.04), 88% reduction in the risk of 30-day mortality (hazard ratio = 0.12; 95% CI, 0.03-0.61; P = 0.01), and 99% reduction in odds of TIC (OR = 0.01; 95% CI, 0.01-0.95; P = 0.05). CONCLUSIONS: PTC RBC administration was associated with a lower risk of 24-hour mortality, 30-day mortality, and TIC in severely injured patients with blunt trauma, warranting further prospective study.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1504
[Cu] Class update date: 150404
[Lr] Last revision date:150404
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1097/SLA.0000000000000674


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