Introduction Thrombelastography (TEG) is a viscoelastic hemostatic assay. We have observed that end stage renal disease (ESRD) and trauma induced coagulopathy (TIC) produce distinctive TEG tracings. We hypothesized that rigorously definable TEG patterns could discriminate between healthy controls and patients with ESRD and TIC. Methods TEG was performed on blood from ESRD patients (n=54) and blood from trauma patients requiring a massive blood transfusion (n=16). Plots of independent TEG parameters were analyzed for patterns coupled to disease state, compared to controls. Decision trees for taxonomic classification were then built using the “R-Project” statistical software. Results Minimally overlapping clusters of TEG results were observed for the three patient groups when coordinate pairs of maximum amplitude (MA) and TEG activated clotting time (ACT) were plotted on orthogonal axes. Based upon these groupings, a taxonomical classification tree was constructed using MA and TEG ACT. Branch points were set at an ACT of 103 seconds, and these branches subdivided for MA at 60.8 mm for the high ACT branch and 72.6 mm for the low ACT branch, providing a correct classification rate of 93.4%. Conclusions ESRD and TIC demonstrate distinct TEG patterns. The coagulopathy of ESRD is typified by a prolonged enzymatic phase of clot formation, with normal-to-elevated final clot strength. Conversely, TIC is typified by prolonged clot formation and weakened clot strength. Our taxonomic categorization constitutes a rigorous system for the algorithmic interpretation of TEG based upon cluster analysis. This will form the basis for clinical decision support software for viscoelastic hemostatic assays.

Adoption of multimodality treatment approach for rectal cancer has resulted in significant improvements in oncologic outcomes. The roles of chemotherapy, radiation, and surgery in rectal cancer treatment are continuously evolving with the goal of achieving the best possible oncologic and functional outcome while minimizing treatment toxicity. The aim of this review is to summarize the most recent trials focusing on organ‐sparing treatment strategies and the optimal selection of patients for neoadjuvant radiation therapy.

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Our study quantified day-of-surgery resource utilization for 14 major surgical procedures by BMI category. The need for additional resources to accommodate patients in higher BMI groups was consistent across all procedures studied and was primarily reflected by lengthened operative times.

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