ABSTRACT
Trauma-induced coagulopathy is classified into primary and secondary coagulopathy, with the former elicited by trauma and traumatic shock itself and the latter being acquired coagulopathy induced by anemia, hypothermia, acidosis, and dilution. Primary coagulopathy consists of disseminated intravascular coagulation and acute coagulopathy of trauma shock (ACOTS). The pathophysiology of ACOTS is the suppression of thrombin generation and neutralization of plasminogen activator inhibitor-1 mediated by activated protein C that leads to hypocoagulation and hyperfibrinolysis in the circulation. This review tried to clarify the validity of activated protein C hypothesis that constitutes the main pathophysiology of the ACOTS in experimental trauma models.
Subject(s)
Animals , Humans , Mice , Acute Disease , Blood Coagulation Disorders , Disease Models, Animal , Disseminated Intravascular Coagulation , Plasminogen Activator Inhibitor 1 , Protein C , Physiology , Thrombin , Wounds and InjuriesABSTRACT
Introduction : <br> This article aims to explain the new Membership of Royal College of General Practitioners (nMRCGP), new postgraduate general practice training in the UK. It will also compare this with that of the Japan Primary Care Association to identify areas requiring further development in postgraduate family medicine training in Japan.<br>Methods : <br> The introduction of the nMRCGP based on the available literature, followed by discussion amongst family physicians and trainees in Japan.<br>Results : <br> Following a comparison between the postgraduate general practice training in the UK and Japan, the following three points were raised : 1) The need for a clear definition of the role that family physicians play in Japan. 2) The importance of formative assessment as part of the membership examination in the form of portfolios. 3) The need for clear competency areas to form the framework for formative assessment, and for the clear standard that trainees are judged against in each of those competency areas.<br>Conclusion : <br> The above results were highlighted and discussed as possible areas for further development in postgraduate family medicine training in Japan.
ABSTRACT
Persistent fifth aortic arch has been thought to be rare but often relevant to systemic circulation, however when it connects to the pulmonary artery (PA) in pulmonary atresia, it may be the sole arterial supply to the lung. This report describes a case of rare arch anomaly including right aortic arch (RAA), PA sling in conjunction with persistent left fifth aortic arch (PLFAA) and left subclavian artery arising from the left fourth arch. The tetralogy of Fallot, pulmonary atresia, and total anomalous of pulmonary venous connection (cardiac) were also diagnosed. A neonate was referred to our hospital for surgical treatment of cardiac and extracardiac anomalies. Persistent fifth aortic arch connecting with pulmonary artery was initially thought to be patent ductus arteriosus (PDA), so prostaglandin E 1 administration was commenced. He underwent emergency colostomy for anal atresia. Subepiglottic tracheal stenosis was diagnosed at initiation of anesthesia. At age 1-month-old, he required systemic to pulmonary shunt and reimplantation of left pulmonary artery through a median sternotomy using extracorporeal circulation. At the operation the PDA was divided and oversewn, and the wall structure was the same as that of a normal artery. The left pulmonary artery behind trachea was dissected and we then cut away and reimplanted to pulmonary trunk. Tracheostomy was performed at the age of two months. With the technical development of diagnostic imaging, the morphological features of arch anomaly were clearly demonstrated, but some understanding of embryological aspects are still required for diagnosis.