Current Issue : July - September Volume : 2015 Issue Number : 3 Articles : 6 Articles
Although tissue-derived high mobility group box 1 (HMGB1) is involved in many aspects of inflammation and tissue injury after\ntrauma, its role in trauma-induced immune suppression remains elusive. Using an established mouse model of peripheral tissue\ntrauma, which includes soft tissue and fracture components, we report here that treatment with anti-HMGB1 monoclonal antibody\nameliorated the trauma-induced attenuated T-cell responses and accumulation of CD11b+Gr-1+ myeloid-derived suppressor cells in\nthe spleens seen two days after injury. Our data suggest that HMGB1 released after tissue trauma contributes to signaling pathways\nthat lead to attenuation of T-lymphocyte responses and enhancement of myeloid-derived suppressor cell expansion....
Surgical brain injury (SBI) is unavoidable during many neurosurgical procedures intrinsically linked to postoperative neurological\ndeficits. We have previously demonstrated that implantation of collagen glycosaminoglycan (CG) following surgical brain injury\ncould significantly promote functional recovery and neurogenesis. In this study we further hypothesized that this scaffold may\nprovide a microenvironment by promoting angiogenesis to favor neurogenesis and subsequent functional recovery. Using the\nrodent model of surgical brain injury as we previously established, we divided Sprague-Dawley male rats (weighting 300ââ?¬â??350 g)\ninto three groups: (1) sham (2) surgical injury with a lesion (L), and (3) L with CG matrix implantation (L + CG). Our results\ndemonstrated that L + CG group showed a statistically significant increase in the density of vascular endothelial cells and blood\nvessels over time. In addition, tissue concentrations of angiogenic growth factors (such as VEGF, FGF2, and PDGF) significantly\nincreased in L + CG group.These results suggest that implantation of a CG scaffold can promote vascularization accompanied by\nneurogenesis. This opens prospects for use of CG scaffolds in conditions such as brain injury including trauma and ischemia...
Introduction. Severity and outcome assessments are crucial in trauma. Our aim was to describe the role of a group of cytokines\n(TNF????, IL-6, IL-10, and HMGB-1) and ICAM-1 as severity and outcome assessment tools and their kinetics in the first 72 h after\nsevere trauma. Materials and Methods. Authors designed a prospective cohort study of severe polytrauma patients (ISS > 15) in a\nlevel 1 Trauma Centre. Cytokines and ICAM-1 levels and Th1/Th2 ratioswere assessed at admission, 24, 48, and 72 h. SIRS, SIRS with\nhypoperfusion, and shock were identified. Outcomes considered were ICU admission, ARDS, MODS, and death. Results. Ninetynine\npatients were enrolled (median ISS: 29 and age 31). There was an early release of pro- and anti-inflammatory mediators with\nhigher values at admission (except for ICAM-1). On admission, IL-6 was associated with ISS, IL-10 with SIRS with hypoperfusion,\nand HMGB-1 with shock. Several cytokines were associated with outcomes, especially IL-6 and IL-10 at 72 h with MODS and\ndeath. Low TNF????/IL-10 and IL-6/IL-10 ratios at 24 and 72 h were associated with MODS and death. Conclusions. Pro- and antiinflammatory\nresponses occur simultaneously and earlier after injury. Cytokines may be useful for outcome assessment, especially\nIL-6 and IL-10. Low Th1/Th2 ratio at 24 to 72 h is associated with MODS and death....
Background.The aim of this study was to cross-culturally adapt the Psychological Injury Risk Indicator (PIRI) and to validate its\npsychometric properties. Methods. Workers from 24 small companies were invited to self-complete the PIRI before undergoing\ntheir routine medical examination at the workplace. All participants (841 out of 845, 99.6%) were also asked to report occupational\ninjuries and episodes of violence that had occurred at the workplace in the previous 12 months and were given the General Health\nQuestionnaire (GHQ12) to complete. Results. Exploratory factor analysis revealed a 4-factor structure, ââ?¬Å?sleep problems,ââ?¬Â ââ?¬Å?recovery\nfailure,ââ?¬Â ââ?¬Å?posttraumatic stress symptoms,ââ?¬Â and ââ?¬Å?chronic fatigue,ââ?¬Â which were the same subscales observed in the original version.\nThe internal consistency was excellent (alpha = 0.932). ROC curve analysis revealed that the PIRI was much more efficient than\nGHQ12 in diagnosing workers who had suffered trauma (workplace violence or injury) in the previous year, as it revealed an area\nunder the curve (AUC) of 0.679 (95% CI: 0.625ââ?¬â??0.734) for the PIRI, while for the GHQ12 the AUC was 0.551 (not significant).\nConclusions. This study, performed on a large population of workers, provides evidence of the validity of the Italian version of the\nPIRI....
This study aimed at determining predictors of in-hospital mortality and prehospital monitoring limitations in severely injured\nintubated blunt trauma patients. We retrospectively reviewed patients� charts. Prehospital vital signs, Injury Severity Score (ISS),\ninitial Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), arterial blood gases, and lactate were compared in two study\ngroups: survivors (n = 40) and nonsurvivors (n = 30). There were no significant differences in prehospital vital signs between\ncompared groups. Nonsurvivors were older (P = 0.006), with lower initial GCS (P < 0.001) and higher ISS (P < 0.001), along\nwith higher lactate (P < 0.001) and larger base deficit (BD; ???? = 0.006), whereas RTS (P = 0.001) was lower in nonsurvivors. For\npredicting mortality, area under the curve (AUC) was calculated: for lactate 0.82 (P < 0.001), for ISS 0.82 (P < 0.001), and for\nBD 0.69 (P = 0.006). Lactate level of 3.4mmol/L or more was 82% sensitive and 75% specific for predicting in-hospital death. In\na multivariate logistic regression model, ISS (P = 0.037), GCS (P = 0.033), and age (P = 0.002) were found to be independent\npredictors of in-hospital mortality. The AUC for regression model was 0.93 (P < 0.001). Increased levels of lactate and BD on\nadmission indicate more severe occult hypoperfusion in nonsurvivors whereas vital signs did not differ between the groups....
Background. Prehospital volume therapy remains widely used after trauma, while evidence regarding its disadvantages is growing.\nTheprimary objective of this study was to investigate the volume administered in a prehospital setting as an independent risk factor\nfor mortality. Material and Methods. Patients who met the following criteria were analyzed retrospectively: Injury Severity Score =\n16, primary admission (between 2002 and 2010), and age = 16 years. The following data had to be available: volume administered\n(including packed red cells), blood pressure, Glasgow Coma Scale, therapeutic measures, and laboratory results. Following a\nunivariate analysis, independent risk factors for mortality after trauma were investigated using a multivariate regression analysis.\nResults. A collective of 7,641 patients met the inclusion criteria, showing that increasing volumes administered in a prehospital\nsetting were an independent risk factor for mortality (odds ratio: 1.34). This tendency was even more pronounced in patients\nwithout severe traumatic brain injury (TBI) (odds ratio: 2.71), while the opposite tendency was observed in patients with TBI.\nConclusions. Prehospital volume therapy in patients without severe TBI represents an independent risk factor for mortality. In such\ncases, respiratory and circulatory conditions should be stabilized during permissive hypotension, and patient transfer should not\nbe delayed....
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