SummaryElectron microscopic and histologic examination of rabbit ear vein segments 4 and 30 min after slight endothelial damage have yielded the following findings :1. Platelets do not adhere to damaged endothelial cells.2. If the vessel wall is denuded of the whole endothelial cell, platelets adhere to the intimai basement lamina as do endothelial cells.3. The distance between adherent platelets as well as endothelial cells and intimai basement lamina measures 10 to 20 mµ, whereas the distance between aggregated platelets is 30 to 60 mµ.4. 5-hydroxytryptamine (5-HT) is released from platelets during viscous metamorphosis at least in part as 5-HT organelles.It should be noted that the presence of collagen fibers is not necessary for platelet thrombus formation in vivo.
SummaryThis is a comparative study of the methods described by H. P. Wright and O’Brien for determining the adhesiveness of thrombocytes. An attempt is made to characterize and statistically correlate both techniques. With the aid of a Coulter Counter for thrombocyte counts, a normal range is presented for human, rat, and rabbit blood. Anticoagulants used are sodium citrate and Heparin.The influence of Cocaine and the Serotonin antagonist Ro 3-0837 was studied on these same substrates, to determine a pharmacological interference with results of either Wright’s test or O’Brien’s. Both drugs are found to induce a statistically significant increase in the “thrombocyte count” as compared to the corresponding controls. These effects are not real but to be attributed to an increase in particle count due to thrombocyte fragmentation as a consequence of drug application. There is no evidence for the claim that these drugs decrease the adhesiveness of thrombocytes.Numerical results of both tests often show a high and statistically significant correlation, especially following the addition of Ro 3-0837. Such is not true of individual blood samples to which no drug has been added. Evidentally, both tests are not specific for the same characteristic of normal blood platelets. But, when Ro 3-0837 is added, the breakdown of unstable platelets is induced; and the corresponding increase in count of thrombocyte fragments is expressed by both tests in the same fashion.
Introduction: As the clinical applications of medical genetics and genomics continue to expand, nongenetics professionals increasingly find themselves in the position of managing patients with genetic conditions. To prepare medical students to handle this future practice demand, it is imperative that they obtain skills and confidence in utilizing credible medical genetics resources to care for patients with genetic conditions. To this end, we developed active learning materials to introduce first-year medical students to these resources. Methods: This approximately 2-hour session targeted first-year medical students (123 students) and combined flipped classroom and small-group collaborative case-based learning models. Students first completed a hands-on preclass exercise, which guided them in navigating the Online Mendelian Inheritance in Man website, and then attended an in-person small-group classroom activity, which provided the opportunity to apply information obtained from credible medical genetics resources to a patient case. At the conclusion of the classroom activity, students voluntarily completed an anonymous survey. Results: Results of student postsession surveys showed that, regardless of previous exposure to medical genetics resources, this session increased both confidence in skills and future intention to use medical genetics resources. Discussion: Since the majority of students were unfamiliar with using specialized medical genetics resources prior to this educational intervention, the session functioned as a practical introduction to these essential resources. We propose that equipping medical students with skills that support inquiry-oriented learning, particularly in the early stage of training, can cultivate the practice of lifelong learning in medical genetics.
Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emergent technology for the treatment of non-compressible torso hemorrhage (NCTH). While aortic occlusion (AO) above the site of hemorrhage provides hemostasis and time for surgical intervention, ischemia-reperfusion injury to the kidneys is a known complication.
We aimed to report the incidence and factors associated with acute kidney injury (AKI) following AO in patients with NCTH or in similar porcine models.
Methods: We searched Pubmed (MEDLINE), Embase, Scopus, and ProQuest Dissertations & Theses from inception to July 2017. We included original studies of trauma patients with NCTH treated with REBOA, or similar porcine studies that included renal parameters, excluding case reports and case series. After duplicate removal, full texts of studies retrieved via the search strategy were evaluated by two authors. Renal parameters (e.g., creatinine concentration, urine output, histopathology) were extracted. Quality of the evidence and risk of bias were assessed.
Results: Twelve out of 2,100 records were included (3 trauma patients, 9 porcine studies). While 1/3 human reports described AO in Zone 1, all swine publications reported Zone 1. All human studies reported renal damage. There were nonetheless inconsistencies in definitions used. Evidence of AKI was reported in 3/9 swine studies.
Conclusions: Consistent reporting of AKI incidence is lacking from human clinical studies of AO in NCTH trauma patients. While comorbidities in trauma patients may contribute to AKI, animal models support the association between AO and AKI. As REBOA is growing in popularity as a therapy for NCTH, further studies determining factors associated with the AKI are needed.
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