The establishment of reference intervals for the ClotPro thromboelastometry device in healthy dogs.

Objective: To establish reference intervals using a new point-of-care thromboelastometry device in dogs for the extrinsically activated test (EX-test), intrinsically activated test (IN-test), fibrin polymerization test (FIB-test), ecarin test (ECA-test), and tissue plasminogen activator test (TPA-test) and to investigate the effects of storage time on the results.

Design: Prospective clinical study in 2022.

Setting: University teaching hospital.

Interobserver reliability for manual analysis of sidestream darkfield videomicroscopy clips after resizing in ImageJ.

Background: Direct assessment of microcirculatory function remains a critical care research tool but approaches for analysis of microcirculatory videomicroscopy clips are shifting from manual to automated algorithms, with a view to clinical application in the intensive care unit. Automated analysis software associated with current sidestream darkfield videomicroscopy systems is demonstrably unreliable; therefore, semi-automated analysis of captured clips should be undertaken in older generations of software. We present a method for capture of microcirculatory clips using current version videomicroscope hardware and resizing of clips to allow compatibility with legacy analysis software.

Mechanical Characterization of the Human Abdominal Wall Using Uniaxial Tensile Testing.

It is generally accepted that the human abdominal wall comprises skin, subcutaneous tissues, muscles and their aponeuroses, and the parietal peritoneum. Understanding these layers and their mechanical properties provides valuable information to those designing procedural skills trainers, supporting surgical procedures (hernia repair), and engineering-based work (in silico simulation). However, there is little literature available on the mechanical properties of the abdominal wall in layers or as a composite in the context of designing a procedural skills trainer.

Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review.

Objective: The objective of this review was to identify quantitative biomechanical measurements of human tissues, the methods for obtaining these measurements, and the primary motivations for conducting biomechanical research.

Introduction: Medical skills trainers are a safe and useful tool for clinicians to use when learning or practicing medical procedures. The haptic fidelity of these devices is often poor, which may be because the synthetic materials chosen for these devices do not have the same mechanical properties as human tissues.

Comparison of sublingual microcirculatory parameters measured by sidestream darkfield videomicroscopy in anesthetized pigs and adult humans.

Background: This study aimed to compare sublingual microcirculatory parameters between anesthetized pigs and conscious adult humans using sidestream darkfield videomicroscopy. The overarching aim of the work was to validate the pig as an experimental model of changes in microcirculatory function following traumatic haemorrhagic shock and resuscitation.

Methods: Fourteen large white pigs and 14 humans were recruited for the study.

Tools measuring high haptic fidelity of procedural skills trainers in physician training and education: a scoping review protocol.

Objective: The objective of this scoping review is to identify instruments that measure the physical haptic fidelity of procedural skills trainers.

Introduction: Procedural skills trainers have demonstrated beneficial outcomes for clinicians when used to practice and rehearse procedures. Despite this, several design flaws currently limit the widespread implementation of such trainers.

The sublingual microcirculation and frailty index in chronic kidney disease patients.

Objective: To examine the relationship between sublingual microcirculatory measures and frailty index in those attending a kidney transplant assessment clinic.

Methods: Patients recruited had their sublingual microcirculation taken using sidestream dark field videomicroscopy (MicroScan, Micro Vision Medical, Amsterdam, the Netherlands) and their frailty index score using a validated short form via interview.

Results: A total of 44 patients were recruited with two being excluded due to microcirculatory image quality scores exceeding 10.

Fascial layers encountered in the lateral skull base region: A cadaveric and radiological analysis.

Background: In our experience, the anterior carotid sheath forms an important plane of dissection when excising temporal bone region cancers. However, its anatomical composition, relationships, and radiological appearance remains unclear.

Methods: Eight sides of cadaveric heads were dissected.

Comparison of a Wearable Accelerometer/Gyroscopic, Portable Gait Analysis System (LEGSYS+) to the Laboratory Standard of Static Motion Capture Camera Analysis.

Examination of gait patterns has been used to determine severity, intervention triage and prognostic measures for many health conditions. Methods that generate detailed gait data for clinical use are typically logistically constrained to a formal gait laboratory setting. This has led to an interest in portable analysis systems for near clinical or community-based assessments.

Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review protocol.

Objective: The objective of this scoping review is to identify the availability of quantitative biomechanical measurements from human tissues. This review will also consider the primary motivations for collecting biomechanical measurements of human tissues. The overall purpose of our research is to develop medical skills trainers that provide better haptic fidelity than those that are currently available.

Surgical applied anatomy: alive and kicking.

Background: Contention exists amongst anatomists, clinicians and surgeons about how much anatomical knowledge medical students need, although what is taught should be aligned with current surgical practice. The aim of this study was to explore the scope of recent advances in applied anatomy as highlighted in the ANZ Journal of Surgery in each of the surgical specialties.

Methods: The 2018 volume of the ANZ Journal of Surgery was narrowed to 254 articles by applying the search term 'anatomy'.

Early Sequential Microcirculation Assessment In Shocked Patients as a Predictor of Outcome: A Prospective Observational Cohort Study.

Objectives: A dysfunctional microcirculation is universal in shock and is often dissociated from global hemodynamic parameters. Persistent microcirculatory derangements reflect ongoing tissue hypoperfusion and organ injury. The initial microcirculatory dysfunction and subsequent resolution could potentially guide therapy and predict outcomes.

A prospective observational study of acute traumatic coagulopathy in traumatic bleeding from the battlefield.

Background: Acute trauma coagulopathy (ATC) after military trauma has not been comprehensively studied. ATC is defined as a prolonged prothrombin time ratio (PTr) or reduced clot amplitude (A5) in viscoelastic testing. Compared to civilian trauma, military trauma has more injuries from explosions and gunshot wounds (GSWs), potentially leading to a different pathophysiology for traumatic coagulopathy.

Radiographic assessment of sarcopenia in the trauma setting: a systematic review.

Background: Compared with similarly injured patients of a younger age, elderly patients have worse outcomes from acute injury. One factor adversely affecting outcomes is sarcopenia, which has been assessed in healthy elderly populations through established clinical and radiological criteria. However, in the acute care setting, no such criteria have been established.

Mapping the Steroid Response to Major Trauma From Injury to Recovery: A Prospective Cohort Study.

Context: Survival rates after severe injury are improving, but complication rates and outcomes are variable.

Objective: This cohort study addressed the lack of longitudinal data on the steroid response to major trauma and during recovery.

Design: We undertook a prospective, observational cohort study from time of injury to 6 months postinjury at a major UK trauma centre and a military rehabilitation unit, studying patients within 24 hours of major trauma (estimated New Injury Severity Score (NISS) > 15).

Combat vascular injury: Influence of mechanism of injury on outcome.

Background: Haemorrhage is the leading cause of death on the battlefield. Seventy percent of injuries are due to explosive mechanisms. Anecdotally, these patients have had poorer outcomes when compared to those with penetrating mechanisms of injury (MOI).

Microcirculatory Impairment Is Associated With Multiple Organ Dysfunction Following Traumatic Hemorrhagic Shock: The MICROSHOCK Study.

Objectives: To assess the relationship between microcirculatory perfusion and multiple organ dysfunction syndrome in patients following traumatic hemorrhagic shock.

Design: Multicenter prospective longitudinal observational study.

Setting: Three U.

Impact of plasma viscosity on microcirculatory flow after traumatic haemorrhagic shock: A prospective observational study.

Background: Preclinical studies report that higher plasma viscosity improves microcirculatory flow after haemorrhagic shock and resuscitation, but no clinical study has tested this hypothesis.

Objective: We investigated the relationship between plasma viscosity and sublingual microcirculatory flow in patients during resuscitation for traumatic haemorrhagic shock (THS).

Methods: Sublingual video-microscopy was performed for 20 trauma patients with THS as soon as feasible in hospital, and then at 24 h and 48 h.

Prehospital haemostatic dressings for trauma: a systematic review.

Background: Haemorrhage is a major cause of mortality and morbidity following both military and civilian trauma. Haemostatic dressings may offer effective haemorrhage control as part of prehospital treatment.

Aim: To conduct a systematic review of the clinical literature to assess the prehospital use of haemostatic dressings in controlling traumatic haemorrhage, and determine whether any haemostatic dressings are clinically superior.

Refining the Trauma and Injury Severity Score (TRISS) to Measure the Performance of the UK Combat Casualty Care System.

Introduction: The Trauma and Injury Severity Score (TRISS) methodology is used in both the UK and US Military trauma registries. The method relies on dividing casualties according to mechanism, penetrating or blunt, and uses different weighting coefficients accordingly. The UK Military Joint Theatre Trauma Registry uses the original coefficients devised in 1987, whereas the US military registry uses updated civilian coefficients, but it is not clear how either registry analyzes explosive casualties according to the TRISS methodology.

What fluids are given during air ambulance treatment of patients with trauma in the UK, and what might this mean for the future? Results from the RESCUER observational cohort study.

Objectives: We investigated how often intravenous fluids have been delivered during physician-led prehospital treatment of patients with hypotensive trauma in the UK and which fluids were given. These data were used to estimate the potential national requirement for prehospital blood products (PHBP) if evidence from ongoing trials were to report clinical superiority.

Setting: The Regional Exploration of Standard Care during Evacuation Resuscitation (RESCUER) retrospective observational study was a collaboration between 11 UK air ambulance services.

Endotheliopathy is associated with higher levels of cell-free DNA following major trauma: A prospective observational study.

Background: Cell free deoxyribonucleic acid (cfDNA) has been proposed as a biomarker of secondary complications following trauma. Raised thrombomodulin and syndecan-1 levels have been used to indicate endotheliopathy, and are associated with inflammation, coagulopathy, and mortality. The current study aimed to analyse the association between cfDNA and biomarkers of endotheliopathy in a cohort of trauma patients, and whether raised levels of cfDNA were associated with poorer clinical outcomes.