David Astapenko

The endothelial glycocalyx (EG) is a dynamic endothelial surface layer composed of proteoglycans, glycosaminoglycans, glycoproteins, and adsorbed plasma proteins that regulates permeability, mechanotransduction, leukocyte trafficking, coagulation, and nitric oxide signaling. In kidney transplantation (KT), the EG is exposed to cumulative injury from recipient uremia, donor instability, preservation, machine perfusion, reperfusion, rejection, and immunosuppressive toxicity. This narrative review summarizes EG biology in KT, with emphasis on biomolecular findings relevant to ischemia–reperfusion injury, delayed graft function, rejection, and chronic allograft injury. Particular attention is given to syndecan-1, heparan sulfate, heparanase, soluble thrombomodulin, matrix metalloproteinases, angiopoietin-2/Tie2 signaling, selectins, miR-126, extracellular vesicles, and urinary or perfusate-derived readouts. Current evidence is biologically coherent but uneven: human data are largely observational, whereas many therapeutic concepts remain preclinical or exploratory. Glycocalyx-centered phenotyping may eventually improve risk stratification and trial enrichment, but clinical implementation will require standardized sampling, sample-source-aware biomarker panels, prospective validation, and clear separation between mechanistic plausibility and proven clinical utility.

BACKGROUND: Surfactant dysfunction contributes to acute respiratory failure following lung contusion. Our experimental study aimed to determine whether exogenous surfactant administration improves regional ventilation and gas exchange in a porcine model of lung contusion. METHODS: Lung contusion was induced in pigs (n=21) using a custom forceps instrument. Animals were randomized into three equal groups. The two treated groups received Curosurf® intrabronchially (5 mg/kg or 10 mg/kg) 30 minutes post-contusion, while the third group served as a control. Vital signs, blood gases, and regional tidal volume distribution via electrical impedance tomography (primary outcome) were monitored for 6 hours. RESULTS: A sustained improvement in regional ventilation of the contused lung region, accompanied by more efficient ventilation, evidenced by a lower ventilatory ratio and PaCO ₂ , was observed in the 10 mg/kg group. A trend toward improvement in systemic oxygenation (PaO ₂ at FiO ₂ =1) was also noted in this group at later time points. The 5 mg/kg dose showed no significant effects. CONCLUSIONS: Early intrabronchial surfactant administration (10 mg/kg) was associated with improved regional ventilation and overall ventilation efficiency in the porcine lung contusion model. These findings suggest potential benefits for managing lung mechanics after severe chest trauma. ( J Trauma Acute Care Surg . 2026;101: 154–161. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.)

Chlormequat is a quaternary ammonium salt used as a plant growth-regulating agent. It is structurally similar to choline, acting at muscarinic and nicotinic receptors. Herein, we present the case of suicidal poisoning with an unknown dose of chlormequat by a 45-year-old woman. Initially, carbofuran was suspected of ingestion. Following ingestion, circulatory arrest occurred. After hospital admission, gastric lavage was performed, and activated charcoal was administered. Initial toxicological analysis identified mild alcohol intoxication, while high-resolution mass spectrometry later discovered a high concentration of chlormequat in the blood and urine. Continuous hemodialysis was indicated to accelerate chlormequat elimination. Antioxidant and Cytosorb therapy were applied to reduce oxidative stress and inflammation. Laboratory results further showed that chlormequat is a mild acetylcholinesterase inhibitor, revealing an additional mechanism of toxicity. However, despite all initial efforts, deep coma persisted with clinical signs of areflexia above C1 and malignant brain edema described on the CT scan. The patient died on day 3 of the ICU stay in palliative care. The authors present complete laboratory and toxicological results, including toxicokinetic data, oxidative stress parameters, acetylcholinesterase, and butyrylcholinesterase activity. In conclusion, modern analytical methods are necessary to provide more effective targeted treatment and could help uncover previously unknown mechanisms of toxicity.

Purpose: It was aimed to determine whether there is a statistically significant difference between various types of displaced supracondylar fractures of the humerus in children with movement impairment according to Flynn’s classification. Methods: Clinical results of 263 patients who were operated on with closed reduction and percutaneous pinning for displaced supracondylar fracture of the humerus were evaluated. Flynn’s classification was used to compare movement impairment. Results: One year after the procedure, only one patient in the category of extension fractures of type II displacement, and only in elbow flexion, had an unsatisfactory treatment outcome according to Flynn. All other patients achieved a satisfactory treatment outcome, with the vast majority, 252 patients (96%), in the excellent category. Four patients were in the good category, one patient in the fair category, and the aforementioned one patient in the poor category. Conclusion: In 1 year after the surgery, the limitation of elbow mobility is usually insignificant regardless of the grade of displacement or type of supracondylar fracture of the humerus. Level of Evidence: Level III—retrospective comparative study.