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Splenic Injury

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141. Endothelium-derived extracellular vesicles promote splenic monocyte mobilization in myocardial infarction (PubMed)

Endothelium-derived extracellular vesicles promote splenic monocyte mobilization in myocardial infarction Transcriptionally activated monocytes are recruited to the heart after acute myocardial infarction (AMI). After AMI in mice and humans, the number of extracellular vesicles (EVs) increased acutely. In humans, EV number correlated closely with the extent of myocardial injury. We hypothesized that EVs mediate splenic monocyte mobilization and program transcription following AMI. Some plasma (...) EVs bear endothelial cell (EC) integrins, and both proinflammatory stimulation of ECs and AMI significantly increased VCAM-1-positive EV release. Injected EC-EVs localized to the spleen and interacted with, and mobilized, splenic monocytes in otherwise naive, healthy animals. Analysis of human plasma EV-associated miRNA showed 12 markedly enriched miRNAs after AMI; functional enrichment analyses identified 1,869 putative mRNA targets, which regulate relevant cellular functions (e.g., proliferation

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2017 JCI insight

142. Splenic injury after colonoscopy requiring splenectomy (PubMed)

Splenic injury after colonoscopy requiring splenectomy We present a case of a middle-aged woman, who presented with abdominal pain less than 24 h following an uneventful colonoscopy for rectal bleeding. Initial diagnosis was thought to be colonic perforation. An urgent CT scan performed owing to dropping haemoglobin and blood pressure revealed a large perisplenic haematoma. An urgent laparotomy was performed in which the patient had a total blood loss of 2500 ml and required splenectomy

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2013 BMJ case reports

143. Is non-operative management feasible for splenic injury due to colonoscopy? (PubMed)

Is non-operative management feasible for splenic injury due to colonoscopy? Colonoscopy is a widely used diagnostic and therapeutic procedure. While it is a relatively safe procedure, there is a risk of some complications. Splenic injury after colonoscopy is a very rare but a life-threatening complication; around 105 cases have been reported in the literature so far. Owing to the rarity of this complication, no management standards were defined. In the literature, most of the patients were (...) managed with operative intervention and less frequently with observation. We report a case of splenic injury and massive hemoperitoneum due to colonoscopy treated non-operatively.

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2013 BMJ case reports

144. Ultrasound Prevents Renal Ischemia-Reperfusion Injury by Stimulating the Splenic Cholinergic Anti-Inflammatory Pathway. (PubMed)

Ultrasound Prevents Renal Ischemia-Reperfusion Injury by Stimulating the Splenic Cholinergic Anti-Inflammatory Pathway. AKI affects both quality of life and health care costs and is an independent risk factor for mortality. At present, there are few effective treatment options for AKI. Here, we describe a nonpharmacologic, noninvasive, ultrasound-based method to prevent renal ischemia-reperfusion injury in mice, which is a model for human AKI. We exposed anesthetized mice to an ultrasound (...) or genetic deficiency of the α7 nicotinic acetylcholine receptor abrogated the protective effect of ultrasound, suggesting the involvement of the cholinergic anti-inflammatory pathway. Taken together, these results suggest that an ultrasound-based treatment could have therapeutic potential for the prevention of AKI, possibly by stimulating a splenic anti-inflammatory pathway.

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2013 Journal of the American Society of Nephrology

145. Prognostic factors for failure of nonoperative management in adults with blunt splenic injury: a systematic review. (PubMed)

Prognostic factors for failure of nonoperative management in adults with blunt splenic injury: a systematic review. Contradictory findings are reported in the literature concerning prognostic factors for failure of nonoperative management (NOM) in the treatment of adults with blunt splenic injury. The objective of this systematic review was to identify prognostic factors for failure of NOM, with or without angiography and embolization.MEDLINE, Embase, and the Cochrane Library databases were (...) prognostic factors were investigated, of which 14 were statistically significant in one or more studies. Strong evidence exists that age of 40 years or above, Injury Severity Score (ISS) of 25 or greater, and splenic injury grade of 3 or greater are prognostic factors for failure of NOM. Moderate evidence was found for a splenic Abbreviated Injury Scale score of 3 or greater, trauma and ISS of less than 0.80, the presence of an intraparenchymal contrast blush, as well as transfusion of 1 unit of packed

2013 The journal of trauma and acute care surgery

146. Optimizing Trauma Multidetector CT Protocol for Blunt Splenic Injury: Need for Arterial and Portal Venous Phase Scans. (PubMed)

Optimizing Trauma Multidetector CT Protocol for Blunt Splenic Injury: Need for Arterial and Portal Venous Phase Scans. To retrospectively compare the diagnostic performance of arterial, portal venous, and dual-phase computed tomography (CT) for blunt traumatic splenic injury.Informed consent was waived for this institutional review board-approved, HIPAA-compliant study. Retrospective record review identified 120 blunt trauma patients (87 male [72.5%] 33 female [27.5%]; age range, 18-94 years (...) ) who had undergone dual-phase abdominal CT within 5 years, including 30 without splenic injury, 30 with parenchymal injury only, 30 with splenic active bleeding, and 30 with intrasplenic pseudoaneurysm. Six radiologists each performed blinded review of 20 different cases, and scored the presence of pseudoaneurysm, active bleeding, parenchymal injury, and hematoma; 20 cases were interpreted by all radiologists. Data analysis included calculation of diagnostic performance measures with confidence

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2013 Radiology

147. Active Hemorrhage and Vascular Injuries in Splenic Trauma: Utility of the Arterial Phase in Multidetector CT. (PubMed)

Active Hemorrhage and Vascular Injuries in Splenic Trauma: Utility of the Arterial Phase in Multidetector CT. To determine whether the addition of arterial phase computed tomography (CT) to the standard combination of portal venous and delayed phase imaging increases sensitivity in the diagnosis of active hemorrhage and/or contained vascular injuries in patients with splenic trauma.The institutional review board approved this HIPAA-compliant retrospective study; the requirement to obtain (...) informed consent was waived. The study included all patients aged 15 years and older who sustained a splenic injury from blunt or penetrating trauma and who underwent CT in the arterial and portal venous phases of image acquisition during a 74-month period (September 2005 to November 2011). CT scans were reviewed by three radiologists, and a consensus interpretation was made to classify the splenic injuries according to the American Association for the Surgery of Trauma splenic injury scale. One

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2013 Radiology

148. Grade IV blunt splenic injury – the role of proximal angioembolization. A case report and review of literature (PubMed)

Grade IV blunt splenic injury – the role of proximal angioembolization. A case report and review of literature The authors present a case of grade IV traumatic spleen rupture (AAST-OIS) and an Injury Severity Score of 21 and a Revised Trauma Score RTS=7.841, which was managed without surgery, but with proximal splenic angioembolization (SAE), with a positive outcome. Indications, types and side-effects of SAE are also discussed with regard to blunt spleen trauma and the benefits of SAE as non (...) -operative treatment approach. It is the first case of a grade IV splenic laceration non-operatively managed to be published in Romania.

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2013 Journal of medicine and life

149. Can we predict delayed undesirable events after blunt injury to the torso visceral organs? (PubMed)

Can we predict delayed undesirable events after blunt injury to the torso visceral organs? Blunt injuries to visceral organs have the potential to lead to delayed pseudoaneurysm formation or organ rupture, but current trauma and surgical guidelines do not recommend repetitive imaging. This study examined the incidence and timing of delayed undesirable events and established advisable timing for follow-up imaging and appropriate observational admission.Patients with blunt splenic (S), liver (L (...) ), or kidney (K) injury treated with non-operative management (NOM) in our institution were included and retrospectively reviewed.From January 2013 to January 2017, 57 patients were admitted with documented blunt visceral organ injuries and 22 patients were excluded. Of 35 patients (L, 10; S, 17; K, 6; L & S, 1; S & K, 1) treated with NOM, 14 (L, 4; S, 9; K, 1) patients underwent transcatheter arterial embolization. Delayed undesirable events occurred in four patients: three patients with splenic

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2018 Acute medicine & surgery

150. Loss of hypoxia inducible factor‐1α aggravates γδ T‐cell‐mediated inflammation during acetaminophen‐induced liver injury (PubMed)

Loss of hypoxia inducible factor‐1α aggravates γδ T‐cell‐mediated inflammation during acetaminophen‐induced liver injury Acetaminophen (APAP)-induced liver injury is closely associated with acute hepatic inflammation. Hypoxia-inducible factor-1 (HIF-1) is activated during immunological processes and regulates gene expressions in various types of immune cells. Although HIF-1 controls the differentiation and functions of conventional T cells in chronic inflammation, the pathological (...) importance of HIF-1 in innate-like T cells during acute inflammation remains unknown. Here, we investigated the role of HIF-1 in innate-like γδ T cells during APAP-induced acute liver injury. In response to APAP administration, T-cell-specific Hif-1α gene knockout mice sustained severe liver damage compared to wild-type control mice but without any impacts on the initial hepatic insult. This severe liver damage was accompanied by excessive neutrophil infiltration into the liver, increased serum

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2018 Hepatology communications

151. Non-operative management versus operative management in high-grade blunt hepatic injury. (PubMed)

Non-operative management versus operative management in high-grade blunt hepatic injury. Surgery used to be the treatment of choice in cases of blunt hepatic injury, but this approach gradually changed over the last two decades as increasing non-operative management (NOM) of splenic injury led to its use for hepatic injury. The improvement in critical care monitoring and computed tomographic scanning, as well as the more frequent use of interventional radiology techniques, has helped to bring (...) about this change to non-operative management. Liver trauma ranges from a small capsular tear, without parenchymal laceration, to massive parenchymal injury with major hepatic vein/retrohepatic vena cava lesions. In 1994, the Organ Injury Scaling Committee of the American Association for the Surgery of Trauma (AAST) revised the Hepatic Injury Scale to have a range from grade I to VI. Minor injuries (grade I or II) are the most frequent liver injuries (80% to 90% of all cases); severe injuries

2015 Cochrane

152. Management of pediatric splenic injuries in Canada. (PubMed)

Management of pediatric splenic injuries in Canada. Nonoperative management (NOM) of blunt splenic injuries has become the standard of care in hemodynamically stable children. This study compares the management of these injuries between pediatric and nonpediatric hospitals in Canada.Data were obtained from the Canadian Institute of Health Information trauma database on all patients aged 2 to 16 years, admitted to a Canadian hospital with a diagnosis of splenic injury between May 2002 and April (...) 2004. Variables included age, sex, associated major injuries, splenic procedures, intensive care unit (ICU) admissions, blood transfusions, and length of stay. Hospitals were coded as pediatric or nonpediatric. Univariate analysis and logistic regression were used to determine associations between hospital type and outcomes.Of 1284 cases, 654 were managed at pediatric hospitals and 630 at nonpediatric centers. Patients at pediatric centers tended to be younger and more likely to have associated

2012 Journal of Pediatric Surgery

153. National variation in outcomes and costs for splenic injury and the impact of trauma systems: a population-based cohort study. (PubMed)

National variation in outcomes and costs for splenic injury and the impact of trauma systems: a population-based cohort study. To measure national variation in splenectomy rates, mortality, and costs for hospitalized patients with splenic injury and the impact of state trauma systems on these outcomes.Using the HCUP State Inpatient Database for 2001, 2004, and 2007, all patients hospitalized with splenic injury were identified from 19 participating states. Multivariate regression was performed (...) variation in the management, outcome, and costs for splenic injury exists in the United States, and may reflect differences in quality of care. Inclusive trauma systems seem to improve outcomes without increasing hospital costs.

2012 Annals of Surgery

154. Less is more: management of pediatric splenic injury. (PubMed)

Less is more: management of pediatric splenic injury. To analyze national trends in the nonoperative management of pediatric splenic injury.Retrospective cohort analysis.All children and adolescents 18 years or younger from 2 national databases who were hospitalized with pediatric splenic injury.Data from 9 years of the National Inpatient Sample database (2000-2008) and 3 years of Kids' Inpatient Database (2000, 2003, and 2006).We calculated and chronicled rates of splenectomy, angiography (...) operative management (odds ratio, 1.24 [95% CI, 1.18-1.31]; P < .001), but less likely to undergo angiography (0.82 [0.76-0.89]; P < .001).Children with pediatric splenic injury are undergoing fewer splenectomies but more angiography. Rural location may be an independent risk factor for operative management. Further studies are needed to assess for disparity in access to and availability of aggressive nonoperative management.

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2012 Archives of Surgery

155. Splenic Injury During Colonoscopy-a Complication that Warrants Urgent Attention. (PubMed)

Splenic Injury During Colonoscopy-a Complication that Warrants Urgent Attention. Colonoscopy is a safe procedure that is performed routinely worldwide. There is, however, a small but significant risk of splenic injury that is often under-recognized. Due to a lack of awareness about this injury, the diagnosis may be delayed, which can lead to an increased risk of morbidity as well as mortality. This paper presents a comprehensive review of the medical literature on colonoscopy-associated splenic (...) injury and describes the clinical presentation and management of this rare but potentially life-threatening complication.A comprehensive literature search identified 102 patients worldwide, including patients from our experience, with splenic injury during colonoscopy. A meta-regression analysis was completed using a mixed generalized linear model for repeated measures to identify risk factors for this rare complication.A total of 75 articles were identified and 102 patients were studied

2012 Journal of Gastrointestinal Surgery

156. Preserved splenic function after angioembolisation of high grade injury. (PubMed)

Preserved splenic function after angioembolisation of high grade injury. After introducing splenic artery embolisation (SAE) in the institutional treatment protocol for splenic injury, we wanted to evaluate the effects of SAE on splenic function and assess the need for immunisation in SAE treated patients.15 SAE patients and 14 splenectomised (SPL) patients were included and 29 healthy blood donors volunteered as controls. Clinical examination, medical history, general blood counts (...) ) of high grade splenic injuries including SAE, was followed by an increase in total leukocyte and platelet counts. Normal levels of immunoglobulins and memory B cells, absence of H-J bodies and preserved splenic size and intraparenchymal blood flow suggest that SAE has only minor impact on splenic function and that immunisation probably is unnecessary.Copyright © 2010 Elsevier Ltd. All rights reserved.

2012 Injury

157. Splenic Injury

Splenic Injury Splenic Injury Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Splenic Injury Splenic Injury Aka: Splenic Injury (...) , Injury of Spleen , Ruptured Spleen , Splenic Rupture From Related Chapters II. Grading: AAST CT Grade for Splenic Injury Precautions May not accurately correlate with surgical findings Does not consistently predict the need for surgical intervention Grade 1 Subcapsular hematoma <10% surface area OR Splenic <1 cm depth into parenchyma Grade 2 Subcapsular hematoma 10-50% surface area OR Splenic 1-3 cm depth into parenchyma (not involving trabecular vessels) Grade 3 Subcapsular hematoma >50% surface

2015 FP Notebook

158. Non-operative management and immune function after splenic injury. (PubMed)

Non-operative management and immune function after splenic injury. There is still considerable controversy about the importance and method of preserving splenic function after trauma. Recognition of the immune function of the spleen and the risk of overwhelming postsplenectomy infection led to the development of spleen-preserving surgery and non-operative management. More recently angiographic embolization has been used to try to reduce failure of conservative management and preserve splenic (...) function.A literature review was performed of the changing treatment of splenic injury over the last century, focusing on whether and how to maintain splenic immune function.Non-operative management continues to be reported as a successful approach in haemodynamically stable patients without other indications for laparotomy, achieving high success rates in both children and adults. Except for haemodynamic instability, reported predictors of failure of conservative treatment should not be seen as absolute

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2012 British Journal of Surgery

159. Non-canonical cholinergic anti-inflammatory pathway-mediated activation of peritoneal macrophages induces Hes1 and blocks ischemia/reperfusion injury in the kidney. (PubMed)

injury including ischemia/reperfusion injury (IRI). The canonical CAP pathway involves activation of splenic alpha7-nicotinic acetylcholine receptor (α7nAChR)-positive macrophages by splenic β2-adrenergic receptor-positive CD4+ T cells. Here we demonstrate that ultrasound or vagus nerve stimulation also activated α7nAChR-positive peritoneal macrophages, and that adoptive transfer of these activated peritoneal macrophages reduced IRI in recipient mice. The protective effect required α7nAChR, and did (...) Non-canonical cholinergic anti-inflammatory pathway-mediated activation of peritoneal macrophages induces Hes1 and blocks ischemia/reperfusion injury in the kidney. The cholinergic anti-inflammatory pathway (CAP) links the nervous and immune systems and modulates innate and adaptive immunity. Activation of the CAP by vagus nerve stimulation exerts protective effects in a wide variety of clinical disorders including rheumatoid arthritis and Crohn's disease, and in murine models of acute kidney

2019 Kidney International

160. Old age increases microglial senescence, exacerbates secondary neuroinflammation, and worsens neurological outcomes after acute traumatic brain injury in mice. (PubMed)

Old age increases microglial senescence, exacerbates secondary neuroinflammation, and worsens neurological outcomes after acute traumatic brain injury in mice. After traumatic brain injury (TBI), individuals aged over 65 years show increased mortality and worse functional outcomes compared with younger persons. As neuroinflammation is a key pathobiological mechanism of secondary injury after TBI, we examined how aging affects post-traumatic microglial responses and functional outcomes. Young (3 (...) -month-old) and aged (18-month-old) male C57Bl/6 mice were subjected to moderate-level controlled cortical impact or sham surgery, and neurological function was evaluated. At 72 hours after injury, brain, blood, and spleen leukocyte counts were assessed ex vivo using flow cytometry. Aged mice demonstrated more severe deficits in forelimb grip strength, balance and motor coordination, spontaneous locomotor activity, and anxiety-like behavior. These animals also exhibited more robust microglial

2019 Neurobiology of Aging

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