Secondary Damage Research Articles

Weisheng-tang protects against ischemic brain injury by modulating microglia activation through the P2Y12 receptor.

Background: Stroke, a leading cause of death and disability, lacks effective treatments. Post-stroke secondary damage worsens the brain microenvironment, further exacerbating brain injury. Microglia's role in responding to stroke-induced damage in peri-infarct regions is crucial. In this study, we explored Weisheng-tang's potential to enhance ischemic outcomes by targeting microglia. Methods: We induced middle cerebral artery occlusion and reperfusion in mice, followed by behavioral assessments and infarct volume analyses after 48h, and examined the changes in microglial morphology through skeleton analysis. Results: Weisheng-tang (300mg/kg) significantly reduced infarction volume and alleviated neurological and motor deficits. The number of activated microglia was markedly increased within the peri-infarct territory, which was significantly reversed by Weisheng-tang. Microglial morphology analysis revealed that microglial processes were retracted owing to ischemic damage but were restored in Weisheng-tang-treated mice. This restoration was accompanied by the expression of the purinergic P2Y12 receptor (P2Y12R), a key regulator of microglial process extension. Weisheng-tang increased neuronal Kv2.1 clusters while suppressing juxtaneuronal microglial activation. The P2Y12R inhibitor-ticagrelor-eliminated the tissue and functional recovery that had been observed with Weisheng-tang after ischemic damage. Discussion: Weisheng-tang improved experimental stroke outcomes by modulating microglial morphology through P2Y12R, shedding light on its neuroprotective potential in ischemic stroke.

Pharmacological management of secondary chronic spinal cord injury: a systematic review.

Spinal cord injury (SCI) may bring lifelong consequences for affected patients and a high financial burden to the health care system. Published peer-reviewed scientific articles identified from EMBASE, Google Scholar, PubMed and Scopus. Surgery and blood pressure management are the main targets in acute SCI to avoid secondary damage. The management of secondary chronic SCI is challenging, with unpredictable outcomes. Given the lack of consensus on pharmacological therapy for acute and secondary chronic SCI, the present study analyses the currently available drugs and treatment options to manage secondary chronic SCI. Different approaches exist for the pharmacological management of secondary chronic SCI. One of the most investigated drugs, 4-aminopyridine, improves central motor conduction and shows improvement in neurological signs. Positive results in different areas have been observed in patients receiving the anti-spastic drugs tizanidine and baclofen or Granulocyte colony-stimulating factor. Growth hormone showed only minimal or no significant effects, and the therapy of secondary chronic SCI with riluzole has been poorly researched to date.

NIR-driven intense UV upconversion films for non-contact high-efficiency prevention of bacterial infections

Bacterial infections on wounds imposes a significant limitation to the wound healing. Although the conventional drug antibacterial dressing is employed for hindering bacterial infection, the inevitable microbial resistance and secondary damage severely limit the quality and speed of wound healing. Herein, the NIR-driven intense UV upconversion (UC) BaLu2F8:80%Yb3+/0.5%Tm3+ microcrystals are, for the first time, designed and fabricated into solid sterilization film to protect the wounds from infections. Equipped with excessive Yb3+ sensitizers, the emission of Yb3+/Tm3+ co-doped monoclinic BaLu2F8 matrix achieve a 175-fold enhancement at the UV band. The UV UC microcrystals was further fabricated into a NIR-to-UV sterilization film with a diameter of 1.5 cm and a thickness of 150 μm using solution casting method, which can efficiently destroy 97 % of E. coli with a NIR irradiation of 5 minutes. Due to the outstanding penetrability of NIR irradiation, the sterilization film under 4 layers gauze dressing can be activated to produce UV photons. The in-vivo mouse tests demonstrate the well-designed NIR-to-UV sterilization film can speed up the wound healing by high-efficient inhibiting E. coli infection under the irradiation of 980 nm NIR laser. The non-contact NIR-driven UV sterilization film require no more drugs and dressing exchange, thus entirely eliminating the effect of microbial resistance and secondary damage from conventional drug dressing. Our work provides a new alternative for constructing highly-efficiency sterilization dressing through the utilization of NIR-to-UV optical conversion materials.

O102 RELATIONSHIP BETWEEN AGTR1 (c.1166 A>C) POLYMORPHISMS AND KIDNEY INJURY IN HYPERTENSION

Background: High blood pressure is the main cause of cardiovascular diseases. Kidney damage is one of the most common organ secondary damage to hypertension. The study of hypertension gene polymorphisms is an important means of precision treatment of primary hypertension. Objectives: The objective of this study was to explore the relationship between AGTR1 (c.1166 A>C) gene polymorphisms and hypertension combined with kidney damage, while exploring the relationship between codominant, dominant and recessive gene model and hypertension with kidney injury and the susceptibility of different genotypes to hypertension with kidney injury. Methods: The distribution of AGTR1 polymorphism in the AGTR1 in hypertensive patients (hypertension group, 292 patients) and hypertension with kidney injury patients (44 patients) were detected and compared by PCR-melting curve method. Results: The genotype distribution of hypertension and combined groups met Hardy-Weinberg equilibrium (p > 0.05); the distribution difference between the three genotypes was statistically significant (p < 0.05), the codominant, dominant and recessive distribution frequency of genotypes (p < 0.05), and no difference between A allele and C allele (p > 0.05). Conclusions: Our study identified the relationship of AGTRA (c.1166 A>C) with hypertension combined with renal injury, and compared the susceptibility of different genetic models, which may provide novel targets for precision gene therapy of hypertension.

Development of Risk Indicator Incorporating Regional Characteristics for Fire-Following Earthquake Risk Assessment

Secondary damages caused by earthquakes, such as fires, tsunamis, and landslides, significantly damage buildings (or structures) and adversely affect humans. Historical cases have highlighted the severe dangers posed by fire-following earthquakes (FFEs). The risk of FFE is determined by regional characteristics, such as the density of buildings and the types of fire-resistant structures. However, researchers have previously evaluated this risk by comparing relative fire burn rates without considering regional characteristics. Hence, a methodology used previously is adopted in this study to calculate regional-level fire burn rates in Pohang City. Subsequently, the relationship between regional characteristics and fire burn rates is examined. Based on the analysis results, a new risk indicator is proposed for evaluating the FFE risk while considering regional characteristics, and the results obtained for Pohang City are compared with those published in the literature (FFE risk ranking in L, Northern, Pohang = 3 or 2 vs. 2).

사이버폭력 실태 및 피해자 보호 강화 방안 - 사이버 불링(Cyber-bullying)을 중심으로

With the advancement of modern science and technology, such as artificial intelligence, cyberbullying is becoming more diverse and brutal. Among the types of cyberbullying, continuous or repeated cyberbullying seriously violates the victim's personal rights. However, the current law cannot properly regulate new types of cyberbullying, such as acts that alienate and exclude victims, online impersonation using deepfake technology, and image bullying. Thus it fails to fully protect victims. As the damage caused by cyberbullying is becoming more serious, with an increasing number of youths experiencing suicidal or self-harming impulses, it is necessary to introduce independent criminal punishment provisions for serious cyberbullying targeting children and youth by referring to legislation in North Carolina, USA and New Zealand, prior to criminal regulation of adults. As regulations and responsibilities for information and communication service providers are being strengthened worldwide, it is necessary to take note of these legislative trends and ensure that information and communication service providers actively respond to victims’ requests to delete harmful information related to cyberbullying in addition to illegal information subject to criminal punishment. Also, it is urgent to introduce a system that requires information and communication service providers to promptly provide anonymous information on the perpetrators in order to prevent the victim's damage from expanding as quickly as possible and to prevent secondary damage. With reference to Australian legislation, a procedure should be established where the Korea Communications Commission directly requests information and communication service providers to provide personal information and contact information even if the victim does not file a civil or criminal suit. In addition, in order to quickly secure evidence when cyber school violence occurs among youth, school principals and teachers in charge should be given the authority to inspect and confiscate cell phones. In this way, in cases where it is difficult to secure evidence, such as when the victim commits suicide, the true nature of school violence should be properly revealed and the youth should be subject to appropriate punishment.

The role of supplementation in traumatic brain injury among athletes and non-athletes population

Introduction: Traumatic brain injury (TBI) is one of the most common causes of death and long-term disability. The consequences following TBI can be persistent and cause life-long implications for survivors. Treatment of TBI may be complex and involve large monetary costs. The frequent injury mechanisms are traffic-related, falls, violence or sport-related accidents. Higher risk of brain injury and its complications indicate that people affected by brain trauma may benefit from the prophylactic and post-traumatic use of certain supplements both in the context of physical performance and in the event of potential injury. Aim of the Study: This narrative review examines the current literature of the role of supplementation before and after TBI and its effects on the patient's outcome. Materials and Methods: A comprehensive search was performed using PubMed and Google Scholar focusing on the literature published up to April 2024. The review included randomized controlled trials, meta-analyses, systematic reviews that focused on the use of creatine monohydrate, omega-3 fatty acids, magnesium and zinc in TBI and among the general population. Data of pathophysiology and epidemiology of TBI and safety profile of supplements were involved. Results: The evidence indicates that the role of supplementation with creatine, omega-3 PUFAs and zinc is important in mitigating secondary damage after TBI, as well as in protecting against damage if administered before injury. Conclusion: Because of the complex and multifactorial nature of the TBI more studies are required to constitute an effective nutrition-based strategy for reducing the cognitive and behavioral deficits associated with this injury. The evidence supporting multiple dietary components to improve a patient's outcome seems strong and the cost of its implementation is low. A group of particular interest that may benefit additionally are athletes who use dietary supplementation in their daily routine.

Syndrome of inappropriate antidiuresis/hyponatremia in COVID-19.

Hyponatremia is the most frequent electrolyte alteration among hospitalized patients and it has been reported in 20-40% of patients with SARS-CoV-2 (COVID-19) infection. Multiple causes of hyponatremia have been hypothesized in these patients. The syndrome of inappropriate antidiuresis (SIAD) has been considered one of the main reasons leading to hyponatremia in this condition. SIAD can be secondary to cytokines release, in particular IL-6. Positive pressure ventilation can be another cause of hyponatremia due to SIAD. Other possible etiologies of hyponatremia in COVID-19 patients can be related to secondary hypocortisolism, nausea, vomiting, heart and kidney damage. Similar to many other clinical conditions, there is strong evidence that hyponatremia is associated with a worse prognosis also in patients with COVID-19 infection. In particular, hyponatremia has been identified as an independent risk of ICU transfer, need of non-invasive ventilation and death. Hyponatremia in COVID-19 patients is in principle acute and symptomatic and should be treated as such, according to the published guidelines. Therefore, patients should be initially treated with i.v. hypertonic saline (3% NaCl) infusion and serum [Na+] should be frequently monitored, in order to remain within a safe rate of correction. There is evidence showing that serum [Na+] correction is associated with a better outcome in different pathologies, including COVID-19 infection.

Temperature-responsive self-contraction nanofiber/hydrogel composite dressing facilitates the healing of diabetic-infected wounds

Bacterial infections and long-term inflammation cause serious secondary damage to chronic diabetic wounds and hinder the wound healing processes. Currently, multifunctional hydrogels have shown promising effects in chronic wound repair. However, traditional hydrogels only keep the wound moist and protect it from bacterial infection, and cannot provide mechanical force to contract the wound edges to achieve facilitated wound closure. Here, an asymmetric composite dressing was created by combining biaxially oriented nanofibers and hydrogel, inspired by the double-layer structure of the traditional Chinese medicinal plaster patch, for managing chronic wounds. Specifically, electrospun Poly-(lactic acid-co-trimethylene carbonate) (PLATMC) nanofibers and methacrylate gelatin (GelMa) hydrogel loaded with Epinecidin-1@chitosan (Epi-1@CS) nanoparticles are assembled as the temperature-responsive self-contracting nanofiber/hydrogel (TSNH) composite dressing. The substrate layer of PLATMC nanofibers combines topological morphology with material properties to drive wound closure through temperature-triggered contraction force. The functional layer of GelMa hydrogel is loaded with Epi-1@CS nanoparticles that combine satisfactory cytocompatibility, and antioxidant, anti-inflammatory, and antibacterial properties. Strikingly, in vivo, the TSNH dressing could regulate the diabetic wound microenvironment, thereby promoting collagen deposition, facilitating angiogenesis, and reducing the inflammatory response, which promotes the rapid healing of chronic wounds. This study highlights the potential of synergizing mechanical and biochemical signals in enhancing chronic wound treatment. Overall, this TSNH composite dressing is provided as a reliable approach to solving the long-standing problem of chronically infected wound healing.

The Diagnosis and Treatment of Tricuspid Regurgitation.

It is estimated that 6% of persons over age 75 have clinically relevant tricuspid regurgitation (TR). This condition carries a high mortality and is of particular interest because of the recent development of new interventional treatments. This review is based on publications that were retrieved by a selective search in the PubMed database for randomized controlled trials (RCTs), observational studies, registry studies, expert recommendations, and current international guidelines. The evidence reveals that TR is an independent cause of mortality. Mortality is correlated with the severity of TR: approximately 35% of patients with severe TR and right heart failure die within 1 year, and about 60% within 3 years. The clinical course varies depending on the etiology (primary TR, atrial/ventricular secondary TR, association with pacemaker systems). In the outpatient setting, timely diagnosis by transthoracic echocardiography is crucial. The options for pharmacotherapy are essentially limited to diuretic treatment (grade 2a recommendation). Early referral to a specialized heart valve center is essential for the prevention of irreversible damage of the right heart and secondary end-organ damage, including cardiohepatic and cardiorenal syndromes. In the heart valve center, an extended diagnostic evaluation with multimodal imaging is followed by a case discussion by the interdisciplinary cardiac team, with individual evaluation of the treatment options. The first randomized controlled trial of treatment for TR yielded a win ratio of 1.48 (95% confidence interval, [1.06; 2.13]) for interventional treatment (edge-to-edge repair) compared to optimal medical therapy. As the understanding of tricuspid regurgitation improves, strategies for its interventional treatment are undergoing steady development, with the aim of lowering the mortality of this condition.

Active Diagnostic Experimentation on Wind Turbine Blades with Vibration Measurements and Analysis

Abstract This paper deals with the key operational problems of wind turbosets, especially offshore, where vibrations are generated by rotor blades, as a consequence of erosive wear or icing. The primary causes of the imbalance of wind turbine rotors have been characterised, the observable symptoms of which include various forms of vibrations, transmitted from the turbine wheel to the bearing nodes of the power train components. Their identification was the result of an active diagnostic experiment, which actually entered the aerodynamic-mass imbalance of a turbine rotor into a wind power train, built as a small scale model. The recording of the observed monitoring parameters (vibration, aerodynamic, mechanical and electrical) made it possible to determine a set of symptoms (syndrome) of the deteriorated (entered) dynamic state of the entire wind turboset. This provides the basis for positive verification of the assumed concept and methodology of diagnostic testing, the constructed laboratory station and the measuring equipment used. For this reason, testing continued, taking into account the known and recognisable faults that most often occur during the operation of offshore wind turbosets. Transferring the results of this type of model research to full-size, real objects makes it possible to detect secondary (fatigue) damage to the elements transmitting torque from the wind turbine rotor to the generator early, especially the thrust bearings or gear wheel teeth.

Effective removal of aged protective coatings from natural heritage in yunyang using strong peelable hydrogels via enhanced interfacial interactions

Organic polymers such polyacrylates, silicones have been used to protect stone-based heritages. However, polymers degrade obviously with time which may lead to secondary damages to heritages. Removal of previously applied but now degraded polymers on stone surface becomes necessary for the long-term preservation of stone heritages. Current cleaning protocol is mainly based on dissolving or extraction of aged polymers by organic liquid, whose kinetics is dominated by the slow diffusion and dissolving processes at the interfaces. Such cleaning process is very time consuming and becomes almost not applicable in large area cleaning. In this work, peelable PVA-borate hydrogels are developed. Organic solvents are introduced to tune gel's mechanical strength and its interfacial adhesion strength. Aged polymer coating can be removed easily by mechanical peeling when appropriate adhesion forces between the gel and aged polymer coating are achieved. Such cleaning protocol has been successfully applied on a fossil wall around 1200 m2. Details, precautions and limitations of this protocol is discussed in this work.

Anti-neuroinflammatory effects of the KIOM -patented Polygonum multiflorum maximized root tuber against LPS-stimulated BV2 Cells

The main pathological mechanism of neurodegeneration is neuroinflammation. It is known that the persistent neuroinflammatory response is harmful by causing secondary nerve tissue damage. Meanwhile, P. multiflorum is a traditional oriental medicinal herb. It has been used as a hematopoietic agent and is used to treat a variety of diseases and conditions. The aim of the present study was to compare the anti-inflammatory efficacy between the commonly available P. multiflorum (C1) and the KIOM-patented in vitro-propagated P. multiflorum (K1), which had higher content of active ingredients and biomass, using culture and cultivation conditions of LPS-induced neuroinflammation. After stimulation with LPS and treatment with C1 and K1 in mouse microglial BV-2 cells, nitric oxide (NO) production, pro-inflammatory cytokine secretion, inducible NO synthase (iNOS) expression, MAPK phosphorylation and transcription factor activity were assessed. We examined the antioxidant effect using DPPH and production of nitric oxide (NO). C1 and K1 suppressed the expression of iNOS and COX-2 and the production of pro-inflammatory cytokines. Furthermore, we determined the levels of inflammatory mediators, such as interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α and mitogen-activated protein kinases and IκBα via Western blotting to understand the regulating mechanisms. Additionally, C1 and K1 also inhibited the activation of p38 and nuclear factor-kappa B (NF-κB) in LPS-stimulated BV2 cells. In all experimental results, excellent anti-neuroinflammatory effects were confirmed at a lower dose in K1 than in C1, which is believed to be due to the increased biomass. Therefore, K1 is expected to be more effective than C1 and can be applied more broadly in the development of prevention and treatment of various inflammatory-mediated neurodegenerative diseases.

The Current Update of Conventional and Innovative Treatment Strategies for Central Nervous System Injury.

This review explores the complex challenges and advancements in the treatment of traumatic brain injury (TBI) and spinal cord injury (SCI). Traumatic injuries to the central nervous system (CNS) trigger intricate pathophysiological responses, frequently leading to profound and enduring disabilities. This article delves into the dual phases of injury-primary impacts and the subsequent secondary biochemical cascades-that worsen initial damage. Conventional treatments have traditionally prioritized immediate stabilization, surgical interventions, and supportive medical care to manage both the primary and secondary damage associated with central nervous system injuries. We explore current surgical and medical management strategies, emphasizing the crucial role of rehabilitation and the promising potential of stem cell therapies and immune modulation. Advances in stem cell therapy, gene editing, and neuroprosthetics are revolutionizing treatment approaches, providing opportunities not just for recovery but also for the regeneration of impaired neural tissues. This review aims to emphasize emerging therapeutic strategies that hold promise for enhancing outcomes and improving the quality of life for affected individuals worldwide.

Enhanced neural recovery and reduction of secondary damage in spinal cord injury through modulation of oxidative stress and neural response

Spinal cord injury (SCI) presents a critical medical challenge, marked by substantial neural damage and persistent functional deficits. This study investigates the therapeutic potential of cold atmospheric plasma (CAP) for SCI, utilizing a tailored dielectric barrier discharge (DBD) device to conduct comprehensive in vivo and in vitro analyses. The findings show that CAP treatment significantly improves functional recovery after SCI, reduces neuronal apoptosis, lowers inflammation, and increases axonal regeneration. These findings illustrate the efficacy of CAP in fostering a conducive environment for recovery by modulating inflammatory responses, enhancing neuronal survival, and encouraging regenerative processes. The underlying mechanism involves CAP’s reactive oxygen species (ROS) reduction, followed by activating antioxidant enzymes. These findings position CAP as a pioneering approach for spinal cord injury (SCI) treatment, presenting opportunities for improved neural recovery and establishing a new paradigm in SCI therapy.

Design, simulation and experiment study of a snap-fit spatial self-locking system for energy absorption

Due to the strong destructiveness and poor predictability of the impact loading, energy absorption structures are easy to cause secondary damage in emergency situations. The proposed self-locking system for energy absorption can effectively solve this problem, but also can realize fast installation, disassembly and free editing. In this paper, a new snap-fit spatial self-locking energy absorption system is designed according to the self-locking idea of mortise and tenon structure. Firstly, the effects of concentrated loading, uniform distributed loading and friction properties on the self-locking characteristics under nine different spatial directions are studied by finite element simulation. Then, the crushing mechanism is revealed by impact experiment, and the performance and engineering adaptability of the existing self-locking energy absorption systems are compared. Finally, the design criteria for the system is derived. The results show that the system will not fly away under the impact loading in any spatial direction, and has good self-locking characteristics, while the friction properties have little effect on the self-locking characteristics of the system. In addition, under the uniform distributed loading, the deformation mode is the most regular in the direction 3, and the specific energy absorption in the direction 9 is as high as 7.07 J/g. Furthermore, when the total number of the structural unit in the self-locking energy absorption system is not less than twelve, the total energy absorption is linear with the number of layers, width and total number of the structural unit. Consequently, this study provides a new research idea for the design and feasibility of the self-locking energy absorption system.

Prevalence of secondary brain injuries and association with trauma circumstances in neuropathologically examined medico-legal autopsy cases with primary head trauma

Primary head injury is often followed by secondary brain damage. However, the association between injury circumstances and the prevalence of secondary injuries remains unclear. We report the prevalence and association of secondary brain injuries with the circumstances in which a head injury was sustained. The sample comprised 76 neuropathologically examined medico-legal autopsy cases with an acute primary head injury. Neuropathology reports were analysed to determine the prevalence of various secondary injuries, i.e., hypoxic-ischaemic neuronal injury, brain oedema, and vascular axonal injury (VAI). The prevalences were compared between cases from three distinct injury circumstances, i.e., fall, assault, and strangulation. The sample had a median age of 49 years (interquartile range 27–73) and 71.1% were identified as male. As for distinct injury circumstances, the sample comprised 14 fall cases, 21 assault victims, and 6 strangulation victims. The prevalence of hypoxic-ischaemic neuronal injury was highest in strangulations (100.0%), followed by assaults (81.0%) and falls (64.3%); of specific brain regions, statistically significant differences between the three case groups were found in frontal and parietal cortex (p ≤ 0.018) and the hippocampus (p = 0.005). Brain oedema was present in approximately half of assault (47.6%) and strangulation cases (50.0%), contrastingly to the lower prevalence in falls (7.1%; p = 0.024). The prevalence of VAI appeared higher among assault (23.8%) and strangulation cases (16.7%) compared to falls (7.1%), but the differences were not statistically significant. We conclude that hypoxic-ischaemic neuronal injury and brain oedema were more prevalent among assault and strangulation cases compared to falls.

A scaling relationship for the width of secondary deformation around strike-slip faults

Simple mechanical arguments suggest that slip along interlocked, rough faults, damages surrounding rocks. The same arguments require that the scale of secondary damage is proportional to the size of geometric irregularities along the main fault. This relationship could apply at all scales, but has, so far, been difficult to observe at the 10s to 100 s of km scales of large, natural faults, often because large-scale deformation is distributed across wide, complex plate-boundary fault systems, like the San Andreas Fault. The geometry and geology of another large-scale plate-boundary strike slip fault—the Queen Charlotte Fault (QCF)—is, in contrast, especially simple. Here, we show that observations of secondary deformation are well-aligned with predictions of stress variations caused by geometric irregularities along the QCF, suggesting a geometric relationship between primary fault geometry and secondary deformation. The analytic stress solution reveals that the highest stresses and highest likelihood of failure are confined to a zone of influence (ZOI) with a width quantified by ZOI=λ/2π, where λ is the wavelength of geometric variations along the main fault. This simple model is consistent with ∼100-km-scale observations along the QCF and can theoretically be used to predict the width of secondary deformation at all scales.

Cell-free DNA kinetics in response to muscle-damaging exercise: A drop jump study.

A significant increase in circulating cell-free DNA (cfDNA) occurs with physical exercise, which depends on the type of exertion and the duration. The aims of this study were as follows: (1) to investigate the time course of cfDNA and conventional markers of muscle damage from immediately after to 96h after muscle-damaging exercise; and (2) to investigate the relationship between cfDNA and indicators of primary (low-frequency fatigue and maximal voluntary isometric contraction) and secondary (creatine kinase and delayed-onset muscle soreness) muscle damage in young healthy males. Fourteen participants (age, 22±2years; weight, 84.4±11.2kg; height, 184.0±7.4cm) performed 50 intermittent drop jumps at 20s intervals. We measured cfDNA and creatine kinase concentrations, maximal voluntary isometric contraction torque, low-frequency fatigue and delayed-onset muscle soreness before and at several time points up to 96h after exercise. Plasma cfDNA levels increased from immediately postexercise until 72h postexercise (P<0.01). Elevation of postexercise cfDNA was correlated with both more pronounced low-frequency fatigue (r=-0.52, P=3.4×10-11) and delayed-onset muscle soreness (r=0.32, P= 0.00019). Levels of cfDNA change in response to severe primary and secondary muscle damage after exercise. Levels of cfDNA exhibit a stronger correlation with variables related to primary muscle damage than to secondary muscle damage, suggesting that cfDNA is a more sensitive marker of acute loss of muscle function than of secondary inflammation or damaged muscle fibres.

Severe Thoracic Trauma Indications and Contraindications for Non-operative and Operative Treatment Strategies

Severe thoracic trauma can occur as a penetrating or blunt mono-injury or as part of a polytrauma. Almost half of all severely injured patients documented in the TraumaRegister DGU were diagnosed with severe chest trauma, defined according to the Abbreviated Injury Scale (AIS) as ≥3. In our own collective, the proportion was even higher with 60%. Emergency surgical treatment with a thoracotomy within the Trauma Resuscitation Unit or within the first hour of admission is an extremely rare intervention in Germany, accounting for 0.9% of severe thoracic injuries. The management of complex polytraumas and extensive pathophysiological reactions to the trauma, as well as knowledge about the development of secondary damage have led to the conclusion that minimally invasive procedures such as video-assisted thoracoscopy (VATS) or inserting a chest drain can resolve most severe thoracic injuries. At <4%, penetrating injuries to the thorax are a rarity. Among blunt thoracic injuries, >6% show an unstable thoracic wall that requires surgical reconstruction. The demographic development in Germany leads to a shift in injury pattern. Low-energy trauma results have lower incidence than higher-grade chest wall injuries with penetrating rib fractures in the pleura, lungs, peri-/myocardium and diaphragm. Sometimes this results in instability of the chest wall with severe restriction of respiratory mechanics, which leads to fulminant pneumonia and even ARDS (Acute Respiratory Distress Syndrome). With this background, surgical chest wall reconstruction has become increasingly important over the past decade. Together with the underlying strong evidence, the assessment of the extend and severity of the trauma and the degree of respiratory impairment are the basis for a structured decision on a non-surgical or surgical-reconstructive strategy, as well as the timing, type and extent of surgery. Early surgery within 72 hours can reduce morbidity (pneumonia rate, duration of intensive care and ventilation) and mortality. In the following article, evidence-based algorithms for surgical and non-operative strategies are discussed in the context on the management of severe thoracic injuries. Thus, a selective literature search was carried out for the leading publications on indications, treatment strategy and therapy recommendations for severe thoracic injury, chest wall reconstruction.