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Article ; Online: Acquired Factor XIII Deficiency in a 19-year-Old Male Following Ballistic Injury.

Rodgers, Skylar C / Carter, Kristen T / Kutcher, Matthew E / Iwuchukwu, Chinenye O

2022 Volume 88, Issue 9, Page(s) 2225–2226

Abstract: Factor XIII deficiency is a rare cause of post-operative bleeding. It poses a diagnostic challenge as standard coagulation tests including prothrombin time, international normalized ratio, and activated partial thromboplastin time are usually normal in ... ...

Abstract	Factor XIII deficiency is a rare cause of post-operative bleeding. It poses a diagnostic challenge as standard coagulation tests including prothrombin time, international normalized ratio, and activated partial thromboplastin time are usually normal in factor XIII deficiency. We present the case of our patient, a 19-year-old male with acquired factor XIII deficiency diagnosed after ballistic injury with a post-operative course complicated by hemorrhage. This case demonstrates an uncommon cause of coagulopathy, acquired factor XIII deficiency, and the challenges it poses to post-operative management. The diagnosis of acquired factor XIII deficiency may be challenging, but a high clinical suspicion is imperative to avoid a missed diagnosis and delayed treatment.
MeSH term(s)	Adult ; Blood Coagulation Disorders/complications ; Blood Coagulation Tests/adverse effects ; Factor XIII Deficiency/complications ; Factor XIII Deficiency/diagnosis ; Humans ; International Normalized Ratio ; Male ; Postoperative Hemorrhage/etiology ; Young Adult
Language	English
Publishing date	2022-04-27
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221091970
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Article ; Online: Adiposity and Coagulation: Predicting Postinjury Coagulation With Advanced Imaging Analysis.

Littlejohn, James B / Grenn, Emily E / Carter, Kristen T / Hazlewood, Rebekah / Sitta, Juliana / Florez, Edward / Howard, Candace M / Kutcher, Matthew E

The Journal of surgical research

2023 Volume 292, Page(s) 190–196

Abstract: Introduction: Anatomic distribution of adipose tissue has demonstrated variable associations with hypercoagulability. Utilizing a retrospective analysis of a previously enrolled prospective cohort, we assessed computed tomography (CT) scan-based ... ...

Abstract	Introduction: Anatomic distribution of adipose tissue has demonstrated variable associations with hypercoagulability. Utilizing a retrospective analysis of a previously enrolled prospective cohort, we assessed computed tomography (CT) scan-based anthropometric and volumetric measures of adiposity as predictors of postinjury hypercoagulability. Methods: Segmentation analysis of arrival CT scans in significantly injured patients at a single level-I trauma center enrolled from December 2017 to August 2021 were analyzed for anthropometric indices of waist circumference (WC) and sagittal abdominal diameter (SAD), and volumetric parameters of visceral adipose tissue, superficial/deep subcutaneous adipose tissue, psoas/paravertebral muscle volume, and abdominal wall muscle volume. Associations with thromboelastography (TEG) were explored. Results: Data from 91 patients showed strong correlations between body mass index and standard anthropometric measures of WC and SAD (P < 0.001); calculated volumes of subcutaneous adipose tissue and visceral adipose tissue (P < 0.001); and ratios of subcutaneous adipose:psoas muscle (SP ratio) and visceral adipose:psoas muscle ratio (both with P < 0.001, respectively). Correlation between TEG maximal amplitude (MA) and body mass index and SAD were not significant, with only weak correlation between TEG-MA and WC (r = 0.238, P = 0.041). Moderate but significant correlations existed between SP ratio and TEG-MA (r = 0.340, P = 0.005), but not visceral adipose:psoas muscle ratio (r = 0.159, P = 0.198). The relationship between TEG-MA and SP ratio remained significant when adjusted for injury severity score and lactate level (b = 0.302, P = 0.001). Conclusions: SP ratio is more strongly correlated with TEG-MA than standard obesity measures, and independently predicts increasing clot strength/stability after injury. Coagulation-relevant measures of sarcopenic obesity can be measured on CT scan, and may be used to optimize thromboprophylaxis strategies for obese injured patients.
MeSH term(s)	Humans ; Adiposity ; Retrospective Studies ; Prospective Studies ; Anticoagulants ; Venous Thromboembolism ; Obesity/complications ; Body Mass Index ; Intra-Abdominal Fat/diagnostic imaging ; Thrombophilia
Chemical Substances	Anticoagulants
Language	English
Publishing date	2023-08-24
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2023.07.048
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Article ; Online: Thromboelastography-Based Evaluation of Gender-Associated Hypercoagulability.

Rodgers, Skylar C / Carter, Kristen T / Patki, Deepti / O'Brien, Robert C / Kutcher, Matthew E

The American surgeon

2022 Volume 88, Issue 11, Page(s) 2619–2625

Abstract: Background: Age, race, and gender differences in coagulation status of healthy volunteers have been reported in previous case series; however, rigorous multivariate analysis adjusting for these factors is lacking. We aimed to investigate the effects of ... ...

Abstract	Background: Age, race, and gender differences in coagulation status of healthy volunteers have been reported in previous case series; however, rigorous multivariate analysis adjusting for these factors is lacking. We aimed to investigate the effects of age, race, and gender on baseline coagulation status in healthy volunteers. Methods: Thirty healthy volunteer controls with no history of bleeding or thrombotic events and no previous anticoagulant or antiplatelet use were recruited. Citrated and heparinized blood samples were drawn, and kaolin and platelet-mapping thromboelastography (TEG) assays performed. Results: Thirty participants had a mean age of 37, mean body mass index of 29 kg/m Discussion: Women at baseline have relatively hypercoagulable fibrin deposition kinetics, platelet contributions to clot formation, and overall clot strength compared to men, even when adjusted for age and race. Additional research is needed to specifically detail the key patient-level factors, clinical implications, and opportunities for tailored therapy related to gender-associated hypercoagulability.
MeSH term(s)	Adult ; Anticoagulants ; Female ; Fibrin ; Humans ; Kaolin/pharmacology ; Male ; Thrombelastography ; Thrombophilia/diagnosis ; Thrombosis
Chemical Substances	Anticoagulants ; Kaolin (24H4NWX5CO) ; Fibrin (9001-31-4)
Language	English
Publishing date	2022-05-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221087905
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Article ; Online: Deleterious effects of plasma-derived cellular debris in a porcine model of hemorrhagic shock.

Buckley, Colin T / Lee, Yannleei L / Michele Schuler, A / Langley, Raymond J / Kutcher, Matthew E / Barrington, Robert / Audia, Jonathon P / Simmons, Jon D

Injury

2023 Volume 55, Issue 5, Page(s) 111300

Abstract: Background: Recent studies identify large quantities of inflammatory cellular debris within Fresh Frozen Plasma (FFP). As FFP is a mainstay of hemorrhagic shock resuscitation, we used a porcine model of hemorrhagic shock and ischemia/reperfusion to ... ...

Abstract	Background: Recent studies identify large quantities of inflammatory cellular debris within Fresh Frozen Plasma (FFP). As FFP is a mainstay of hemorrhagic shock resuscitation, we used a porcine model of hemorrhagic shock and ischemia/reperfusion to investigate the inflammatory potential of plasma-derived cellular debris administered during resuscitation. Methods: The porcine model of hemorrhagic shock included laparotomy with 35 % hemorrhage (Hem), 45 min of ischemia from supraceliac aortic occlusion with subsequent clamp release (IR), followed by protocolized resuscitation for 6 h. Cellular debris (Debris) was added to the resuscitation phase in three groups. The four groups consisted of Hem + IR (n = 4), Hem + IR + Debris (n = 3), Hem + Debris (n = 3), and IR + Debris (n = 3). A battery of laboratory, physiologic, cytokine, and outcome data were compared between groups. Results: As expected, the Hem + IR group showed severe time dependent decrements in organ function and physiologic parameters. All animals that included both IR and Debris (Hem + IR + Debris or IR + Debris) died prior to the six-hour end point, while all animals in the Hem + IR and Hem + Debris survived. Cytokines measured at 30-60 min after initiation of resuscitation revealed significant differences in IL-18 and IL-1β between all groups. Conclusions: Ischemia and reperfusion appear to prime the immune system to the deleterious effects of plasma-derived cellular debris. In the presence of ischemia and reperfusion, this model showed the equivalency of 100 % lethality when resuscitation included quantities of cellular debris at levels routinely administered to trauma patients during transfusion of FFP. A deeper understanding of the immunobiology of FFP-derived cellular debris is critical to optimize resuscitation for hemorrhagic shock.
MeSH term(s)	Humans ; Swine ; Animals ; Shock, Hemorrhagic ; Blood Transfusion ; Cytokines ; Resuscitation ; Ischemia
Chemical Substances	Cytokines
Language	English
Publishing date	2023-12-23
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2023.111300
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Article ; Online: Alterations in platelet behavior after major trauma: adaptive or maladaptive?

Vulliamy, Paul / Kornblith, Lucy Z / Kutcher, Matthew E / Cohen, Mitchell J / Brohi, Karim / Neal, Matthew D

Platelets

2020 Volume 32, Issue 3, Page(s) 295–304

Abstract: Platelets are damage sentinels of the intravascular compartment, initiating and coordinating the primary response to tissue injury. Severe trauma and hemorrhage induce profound alterations in platelet behavior. During the acute post-injury phase, ... ...

Abstract	Platelets are damage sentinels of the intravascular compartment, initiating and coordinating the primary response to tissue injury. Severe trauma and hemorrhage induce profound alterations in platelet behavior. During the acute post-injury phase, platelets develop a state of impaired
MeSH term(s)	Blood Platelets/pathology ; Female ; Humans ; Male ; Platelet Count/methods ; Wounds and Injuries/blood
Language	English
Publishing date	2020-01-27
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1034283-7
ISSN	1369-1635 ; 0953-7104
ISSN (online)	1369-1635
ISSN	0953-7104
DOI	10.1080/09537104.2020.1718633
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Article ; Online: Organ donation in the surgical ICU: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document.

Seshadri, Anupamaa / Cuschieri, Joseph / Kaups, Krista L / Knowlton, Lisa Marie / Kutcher, Matthew E / Pathak, Abhijit / Rappold, Joseph / Rinderknecht, Tanya / Stein, Deborah M / Young, Jason / Michetti, Christopher P

Trauma surgery & acute care open

2023 Volume 8, Issue 1, Page(s) e001107

Language	English
Publishing date	2023-05-12
Publishing country	England
Document type	Journal Article
ISSN	2397-5776
ISSN (online)	2397-5776
DOI	10.1136/tsaco-2023-001107
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Article ; Online: Weight Bias: Examining Achalasia Therapy in the Obese Patient.

Rhie, Ryan Y / Chamblee, Dakota / Walker, Savannah / Mehaffey, Niall / Jenkins, Haley / Kutcher, Matthew E / Moremen, Jacob

The American surgeon

2022 Volume 88, Issue 9, Page(s) 2194–2197

Abstract: We hypothesize that obesity is a common diagnosis in those with achalasia at our institution but time to diagnosis and treatment is longer compared to normal weight counterparts due to implicit bias. We retrospectively reviewed all adult patients between ...

Abstract	We hypothesize that obesity is a common diagnosis in those with achalasia at our institution but time to diagnosis and treatment is longer compared to normal weight counterparts due to implicit bias. We retrospectively reviewed all adult patients between 1/1/2013 and 6/31/2020 with a diagnosis of achalasia. Demographics, comorbidities, Eckardt scores, interventions, complications, time to consult, duration of symptoms, and follow-up were evaluated. More than half of the patients were seen in the most recent 2 years following POEM introduction and 138 had available BMI data. 46 were obese (33%) and 92 were non-obese (67%). Obese patients reported a shorter duration of symptoms prior to seeking treatment 12 versus 24 months. There was no difference in time to intervention or procedure offered. There was a non-significant trend toward higher leak (11 vs 5%) and overall complication rate (19 vs 17%) in obese patients. In follow-up 98 patients had BMI data. There was a a significant difference in mean BMI change -1.2 +/- 4.2 kg/m
MeSH term(s)	Adult ; Esophageal Achalasia/complications ; Esophageal Achalasia/diagnosis ; Esophageal Achalasia/therapy ; Esophageal Sphincter, Lower ; Esophagoscopy ; Humans ; Natural Orifice Endoscopic Surgery/methods ; Obesity/complications ; Retrospective Studies ; Treatment Outcome ; Weight Gain ; Weight Prejudice
Language	English
Publishing date	2022-05-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221080418
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Article ; Online: Survey of venous thromboembolism prophylaxis in trauma patients: current prescribing practices and concordance with clinical practice guidelines.

Alexander, Kaitlin M / Butts, Charles Caleb / Lee, Yan-Leei Larry / Kutcher, Matthew E / Polite, Nathan / Haut, Elliott R / Spain, David / Berndtson, Allison E / Costantini, Todd W / Simmons, Jon D

Trauma surgery & acute care open

2023 Volume 8, Issue 1, Page(s) e001070

Abstract: Objectives: Pharmacological venous thromboembolism (VTE) prophylaxis is recommended in the vast majority of trauma patients. The purpose of this study was to characterize current dosing practices and timing of initiation of pharmacological VTE ... ...

Abstract	Objectives: Pharmacological venous thromboembolism (VTE) prophylaxis is recommended in the vast majority of trauma patients. The purpose of this study was to characterize current dosing practices and timing of initiation of pharmacological VTE chemoprophylaxis at trauma centers. Methods: This was an international, cross-sectional survey of trauma providers. The survey was sponsored by the American Association for the Surgery of Trauma (AAST) and distributed to AAST members. The survey included 38 questions about practitioner demographics, experience, level and location of trauma center, and individual/site-specific practices regarding the dosing, selection, and timing of initiation of pharmacological VTE chemoprophylaxis in trauma patients. Results: One hundred eighteen trauma providers responded (estimated response rate 6.9%). Most respondents were at level 1 trauma centers (100/118; 84.7%) and had >10 years of experience (73/118; 61.9%). While multiple dosing regimens were used, the most common dose reported was enoxaparin 30 mg every 12 hours (80/118; 67.8%). The majority of respondents (88/118; 74.6%) indicated adjusting the dose in patients with obesity. Seventy-eight (66.1%) routinely use antifactor Xa levels to guide dosing. Respondents at academic institutions were more likely to use guideline-directed dosing (based on the Eastern Association of the Surgery of Trauma and the Western Trauma Association guidelines) of VTE chemoprophylaxis compared with those at non-academic centers (86.2% vs 62.5%; p=0.0158) and guideline-directed dosing was reported more often if the trauma team included a clinical pharmacist (88.2% vs 69.0%; p=0.0142). Wide variability in initial timing of VTE chemoprophylaxis after traumatic brain injury, solid organ injury, and spinal cord injuries was found. Conclusions: A high degree of variability exists in prescribing and monitoring practices for the prevention of VTE in trauma patients. Clinical pharmacists may be helpful on trauma teams to optimize dosing and increase prescribing of guideline-concordant VTE chemoprophylaxis.
Language	English
Publishing date	2023-05-12
Publishing country	England
Document type	Journal Article
ISSN	2397-5776
ISSN (online)	2397-5776
DOI	10.1136/tsaco-2022-001070
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Article ; Online: Increased platelet mitochondrial function correlates with clot strength in a rodent fracture model.

Littlejohn, James Blake / Grenn, Emily Evans / Carter, Kristen T / Palei, Ana C / Spradley, Frank T / Hosler, Jonathan P / Hoang, Ngoc H / Edwards, Kristin S / Kutcher, Matthew E

The journal of trauma and acute care surgery

2023 Volume 96, Issue 3, Page(s) 378–385

Abstract: ... displayed higher liver mitochondria Complex I-driven respiration (895.6 ± 123.7 vs. 622.1 ± 48.7 mmol e ...

Abstract	Background: Thromboelastographic measures of clot strength increase early after injury, portending higher risks for thromboembolic complications during recovery. Understanding the specific role of platelets is challenging because of a lack of clinically relevant measures of platelet function. Platelet mitochondrial respirometry may provide insight to global platelet function but has not yet been correlated with functional coagulation studies. Methods: Wistar rats underwent anesthesia and either immediate sacrifice for baseline values (n = 6) or (1) bilateral hindlimb orthopedic injury (n = 12), versus (2) sham anesthesia (n = 12) with terminal phlebotomy/hepatectomy after 24 hours. High-resolution respirometry was used to measure basal respiration, mitochondrial leak, maximal oxidative phosphorylation, and Complex IV activity in intact platelets; Complex I- and Complex II-driven respiration was measured in isolated liver mitochondria. Results were normalized to platelet number and protein mass, respectively. Citrated native thromboelastography (TEG) was performed in triplicate. Results: Citrated native TEG maximal amplitude was significantly higher (81.0 ± 3.0 vs. 73.3 ± 3.5 mm, p < 0.001) in trauma compared with sham rats 24 hours after injury. Intact platelets from injured rats had higher basal oxygen consumption (17.7 ± 2.5 vs. 15.1 ± 3.2 pmol O 2 /[s × 10 8 cells], p = 0.045), with similar trends in mitochondrial leak rate ( p = 0.19) when compared with sham animals. Overall, platelet basal respiration significantly correlated with TEG maximal amplitude ( r = 0.44, p = 0.034). As a control for sex-dependent systemic mitochondrial differences, females displayed higher liver mitochondria Complex I-driven respiration (895.6 ± 123.7 vs. 622.1 ± 48.7 mmol e - /min/mg protein, p = 0.02); as a control for systemic mitochondrial effects of injury, no liver mitochondrial respiration differences were seen. Conclusion: Platelet mitochondrial basal respiration is increased after injury and correlates with clot strength in this rodent hindlimb fracture model. Several mitochondrial-targeted therapeutics exist in common use that are underexplored but hold promise as potential antithrombotic adjuncts that can be sensitively evaluated in this preclinical model.
MeSH term(s)	Female ; Animals ; Rats ; Rodentia ; Rats, Wistar ; Mitochondria/metabolism ; Blood Platelets/metabolism ; Hemostasis ; Thrombelastography/methods ; Fractures, Bone
Language	English
Publishing date	2023-09-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000004204
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Article ; Online: Circulating Total Cell-Free DNA Levels Are Increased in Hypertensive Disorders of Pregnancy and Associated with Prohypertensive Factors and Adverse Clinical Outcomes.

Amaral, Lorena M / Sandrim, Valeria C / Kutcher, Matthew E / Spradley, Frank T / Cavalli, Ricardo C / Tanus-Santos, Jose E / Palei, Ana C

International journal of molecular sciences

2021 Volume 22, Issue 2

Abstract: Previous studies have described increased circulating cell-free DNA (cfDNA) in hypertensive disorders of pregnancy (HDP). Here, we aimed first to confirm this information using a simple, but sensible fluorescent assay, and second to investigate whether ... ...

Abstract	Previous studies have described increased circulating cell-free DNA (cfDNA) in hypertensive disorders of pregnancy (HDP). Here, we aimed first to confirm this information using a simple, but sensible fluorescent assay, and second to investigate whether total cfDNA is associated with circulating factors known to be linked to the pathophysiology of HDP as well as with poor maternal-fetal outcomes. We studied 98 women with healthy pregnancies (HP), 88 with gestational hypertension (GH), and 91 with preeclampsia (PE). Total DNA was extracted from plasma using the QIAamp DNA blood mini kit and quantified using Quant-iT™ PicoGreen
MeSH term(s)	Adult ; Cell-Free Nucleic Acids/blood ; DNA/blood ; Endoglin/blood ; Female ; Fetal Growth Retardation/blood ; Fetal Growth Retardation/pathology ; Humans ; Hypertension/blood ; Hypertension/pathology ; Hypertension, Pregnancy-Induced/blood ; Hypertension, Pregnancy-Induced/pathology ; Matrix Metalloproteinase 2/blood ; Pre-Eclampsia/blood ; Pre-Eclampsia/pathology ; Pregnancy ; Pregnancy Trimester, First/blood ; Premature Birth/blood ; Premature Birth/pathology ; Vascular Endothelial Growth Factor Receptor-1/blood
Chemical Substances	Cell-Free Nucleic Acids ; ENG protein, human ; Endoglin ; DNA (9007-49-2) ; FLT1 protein, human (EC 2.7.10.1) ; Vascular Endothelial Growth Factor Receptor-1 (EC 2.7.10.1) ; Matrix Metalloproteinase 2 (EC 3.4.24.24)
Language	English
Publishing date	2021-01-08
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms22020564
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