| 1. |
- Weinstein, John N., et al.
(författare)
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The cancer genome atlas pan-cancer analysis project
- 2013
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Ingår i: Nature Genetics. - : Springer Science and Business Media LLC. - 1061-4036 .- 1546-1718. ; 45:10, s. 1113-1120
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Forskningsöversikt (refereegranskat)abstract
- The Cancer Genome Atlas (TCGA) Research Network has profiled and analyzed large numbers of human tumors to discover molecular aberrations at the DNA, RNA, protein and epigenetic levels. The resulting rich data provide a major opportunity to develop an integrated picture of commonalities, differences and emergent themes across tumor lineages. The Pan-Cancer initiative compares the first 12 tumor types profiled by TCGA. Analysis of the molecular aberrations and their functional roles across tumor types will teach us how to extend therapies effective in one cancer type to others with a similar genomic profile. © 2013 Nature America, Inc. All rights reserved.
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| 2. |
- Coccolini, F., et al.
(författare)
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Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry
- 2020
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Ingår i: Updates in Surgery. - : Springer Science and Business Media LLC. - 2038-131X .- 2038-3312. ; 2020:72, s. 527-536
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Tidskriftsartikel (refereegranskat)abstract
- EndoVascular and Hybrid Trauma Management (EVTM) has been recently introduced in the treatment of severe pelvic ring injuries. This multimodal method of hemorrhage management counts on several strategies such as the REBOA (resuscitative endovascular balloon occlusion of the aorta). Few data exist on the use of REBOA in patients with a severely injured pelvic ring. The ABO (aortic balloon occlusion) Trauma Registry is designed to capture data for all trauma patients in hemorrhagic shock where management includes REBOA placement. Among all patients included in the ABO registry, 72 patients presented with severe pelvic injuries and were the population under exam. 66.7% were male. Mean and median ISS were respectively 43 and 41 (SD ± 13). Isolated pelvic injuries were observed in 12 patients (16.7%). Blunt trauma occurred in 68 patients (94.4%), penetrating in 2 (2.8%) and combined in 2 (2.8%). Type of injury: fall from height in 15 patients (23.1%), traffic accident in 49 patients (75.4%), and unspecified impact in 1 patient (1.5%). Femoral access was gained pre-hospital in 1 patient, in emergency room in 43, in operating room in 12 and in angio-suite in 16. REBOA was positioned in zone 1 in 59 patients (81,9%), in zone 2 in 1 (1,4%) and in zone 3 in 12 (16,7%). Aortic occlusion was partial/periodical in 35 patients (48,6%) and total occlusion in 37 patients (51,4%). REBOA associated morbidity rate: 11.1%. Overall mortality rate was 54.2% and early mortality rate (≤ 24h) was 44.4%. In the univariate analysis, factors related to early mortality (≤ 24h) are lower pH values (p = 0.03), higher base deficit (p = 0.021), longer INR (p = 0.012), minor increase in systolic blood pressure after the REBOA inflation (p = 0.03) and total aortic occlusion (p = 0.008). None of these values resulted significant in the multivariate analysis. In severe hemodynamically unstable pelvic trauma management, REBOA is a viable option when utilized in experienced centers as a bridge to other treatments; its use might be, however, accompanied with severe-to-lethal complications. © 2020, Italian Society of Surgery (SIC).
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| 3. |
- Reva, V. A., et al.
(författare)
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Resuscitative endovascular balloon occlusion of the aorta : what is the optimum occlusion time in an ovine model of hemorrhagic shock?
- 2018
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Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Berlin/Heidelberg. - 1863-9933 .- 1863-9941. ; 44:4, s. 511-518
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to evaluate the early survival and organ damage following 30 and 60 min of thoracic resuscitative endovascular balloon occlusion of the aorta (REBOA) in an ovine model of severe hemorrhagic shock.Eighteen sheep were induced into shock by undergoing a 35 % controlled exsanguination over 30 min. Animals were randomized into three groups: 60-min REBOA 30 min after the bleeding (60-REBOA), 30-min REBOA 60 min after the bleeding (30-REBOA) and no-REBOA control (n-REBOA). Resuscitation with crystalloids and whole blood was initiated 20 and 80 min after the induction of shock. Animals were observed for 24 h with serial potassium and lactate measurements. Autopsy was performed to evaluate organ damage.Two animals of the n-REBOA group died within 90 min of shock induction; no hemorrhagic deaths were observed in the REBOA groups. Twenty-four-hour survival for the 60-, 30-, and n-REBOA groups was 0/6, 5/6, and 4/6 (P = 0.002). In 60-REBOA, potassium and lactate were increased at 270-min time point: from 4.3 to 5.1 mEq/l and from 3.7 to 5.1 mmol/L, respectively. Both these values were significantly higher than in the n-REBOA group (P = 0.029 for potassium and P = 0.039 for lactate). Autopsy revealed acute tubular necrosis in all died REBOA group animals.In this ovine model of severe hemorrhagic shock, REBOA can be used to prevent early death from hemorrhage; however, 60 min of occlusion results in significant metabolic derangement and organ damage that offsets this gain.
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| 4. |
- Shchegolev, A.V., et al.
(författare)
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Эндоваскулярная баллонная окклюзия аорты в комплексе реанимационного контроля повреждений у пострадавших с острой массивной кровопотерей: ретроспективное псевдорандомизированное исследование : [Endovascular balloon occlusion of the aorta in the complex of damage control resuscitation in patients with acute massive blood loss: a retrospective propensity score matched analysis]
- 2022
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Ingår i: Annals of Critical Care. - : Practical Medicine Publishing House LLC. - 1726-9806. ; 2022:2, s. 41-51
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Tidskriftsartikel (refereegranskat)abstract
- АКТУАЛЬНОСТЬ. Повышение качества медицинской помощи пострадавшим с тяжелой сочетанной травмой в период шока связывают с применением новых методов «эндоваскулярной реанимации», наиболее распространенным и эффективным из которых является метод реанимационной эндоваскулярной баллонной окклюзии аорты (РЭБОА). ЦЕЛЬ ИССЛЕДОВАНИЯ. Сравнение исходов лечения пострадавших с крайне тяжелой сочетанной травмой в России и за рубежом в аспекте применения концепции damage control и «эндоваскулярной реанимации». МАТЕРИАЛЫ И МЕТОДЫ. Проведен ретроспективный анализ и псевдорандомизированное сравнение случаев оказания помощи с использованием РЭБОА в России (n = 24) и мире (n = 241) в период с 2013 по 2020 г. в исследование вошли пострадавшие в крайне тяжелом, терминальном состоянии с нестабильными показателями гемодинамики (шоком), системной гипоперфузией и признаками продолжающегося полостного кровотечения. РЕЗУЛЬТАТЫ. РЭБОА в обеих группах выполняли в среднем через 22 мин от момента поступления, в большинстве случаев (65–75 %) — окклюзию грудной аорты, что приводило к подъему АД на 40–50 мм рт. ст. и позволяло тем самым временно стабилизовать гемодинамику на время выполнения операции и начала гемотрансфузии. Выявлены существенные различия между отечественной выборкой и группой сопоставления по объему и характеру проводимой инфузионно-трансфузионной терапии (ИТТ) в ранний период травмы. Общий объем ИТТ был достоверно выше в зарубежной выборке (p = 0,001), причем за счет переливания компонентов крови: эритроцитной взвеси и тромбоконцентрата (p < 0,05 как до РЭБОА, так и после). Коллоидные растворы вовсе не применяли в зарубежной группе (p < 0,001). Выявлено, что раннее введение достаточного объема компонентов крови способствует увеличению выживаемости до 50 % (95%-й доверительный интервал [95% ДИ] 43–56 %; р = 0,002). ВЫВОДЫ. РЭБОА является эффективным методом временной стабилизации гемодинамики у пострадавших с крайне тяжелой сочетанной травмой, однако ее результативность в первую очередь определяется качеством ИТТ и реаниматологической помощи в целом.
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| 5. |
- Reva, Viktor A., et al.
(författare)
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Field and en route resuscitative endovascular occlusion of the aorta : A feasible military reality?
- 2017
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Ingår i: Journal of Trauma and Acute Care Surgery. - Philadelphia, PA, United States : Lippincott Williams & Wilkins. - 2163-0755 .- 2163-0763. ; 83:1, s. S170-S176
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Severe non-compressible torso hemorrhage (NCTH) remains a leading cause of potentially preventable death in modern military conflicts. Resuscitative endovascular occlusion of the aorta (REBOA) has demonstrated potential as an effective adjunct to the treatment of NCTH in the civilian early hospital and even pre-hospital settings - but the application of this technology for military pre-hospital use has not been well described. We aimed to assess the feasibility of both field and en route pre-hospital REBOA in the military exercise setting simulating a modern armed conflict.METHODS: Two adult male Sus Scrofa underwent simulated junctional combat injury in the context of a planned military training exercise. Both underwent zone I REBOA in conjunction with standard tactical combat casualty care (TCCC) interventions - one during point of injury care and the other during en route flight care. Animals were sequentially evacuated to two separate Forward Surgical Teams (FSTs) by rotary wing platform where the balloon position was confirmed by chest X-Ray. Animals then underwent different damage control thoracic and abdominal procedures before euthanasia.RESULTS: The first swine underwent immediate successful REBOA at the point of injury 7:30 minutes after the injury. It required 6 minutes total from initiation of procedure to effective aortic occlusion. Total occlusion time was 60 minutes. In the second animal, the REBOA placement procedure was initiated immediately after take-off (17:40 minutes after the injury). Although the movements and vibration of flight were not significant impediments, we only succeeded to put a 6-Fr sheath into a femoral artery during the 14 minutes flight due to lighting and visualization challenges. After the sheath had been upsized in the FST, the REBOA catheter was primarily placed in zone I followed by its replacement to zone III. Both animals survived to study completion and the termination of training. No complications were observed in either animal.CONCLUSION: Our study demonstrates the potential feasibility of REBOA for use during tactical field and en route (flight) care of combat casualties. Further study is needed to determine the optimal training and utilization protocols required to facilitate the effective incorporation of REBOA into military pre-hospital care capabilities.
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