Severe Trauma Group Research Articles

Real-time monitoring of vitamin C levels in trauma patients by electron-spin resonance spectrometry

BackgroundIn critically ill patients, healthy vitamin C levels are important to avoid an imbalance in reactive oxygen species. To achieve this, oxidative stress levels in emergency patients need to be accurately measured in real-time. However, normally, reactive oxygen/nitrogen species are short-lived, rendering measurement difficult; moreover, measurement of relatively stable antioxidants and other oxidative stress markers in real-time is challenging. Therefore, we used electron-spin resonance spectrometry (ESR) to assess vitamin C levels, clarify their relationship with patients’ severity, and establish more effective vitamin C therapy in critically ill patients.MethodsWe studied 103 severely ill emergency patients and 15 healthy volunteers. Vitamin C radical (VCR/dimethyl sulfoxide [DMSO]) values were analyzed in arterial blood samples by ESR at admission and once daily thereafter during the acute recovery phase. Severity scores were calculated. The relationship between these scores and VCR/DMSO values and chronological changes in VCR/DMSO values were analyzed.ResultsSerum VCR/DMSO values were significantly lower in critically ill patients than in healthy volunteers (0.264 ± 0.014 vs. 0.935 ± 0.052, p < 0.05), particularly in the severe trauma group and the cardiopulmonary arrest/post-cardiac arrest syndrome group. VCR/DMSO values and various severity scores did not correlate at admission; however, they correlated with SOFA scores from days 2–6. VCR/DMSO values remained low from the first measurement day through Day 6 of illness.ConclusionsVitamin C levels were low at admission, remained low with conventional nutritional support, and did not correlate with the initial patient’s severity; however, they correlated with patients’ severity after admission. Some patients had normal vitamin C levels. Therefore, vitamin C levels should be measured in real-time and supplemented if they are below normal levels.Trial registrationRetrospectively registered.

Changes in Lipid biomarker related to trauma severity in intertrochanteric fracture patients.

This study aimed to identify whether there are elevations or declines in specific plasma lipids in intertrochanteric fracture (ITF) patients which might serve as potential biomarkers for assessing the severity of trauma, or therapeutic targets for controlling post-traumatic responses. Ten metal work removal patients were enrolled. Their preoperative blood samples served as the control group (C group). Their 24-hour postoperative blood samples served as the moderate trauma group (M group). The ITF group was composed of 12 intertrochanteric fracture patients. A total of 707 lipid species were identified from 32 plasma samples (10 controls, 10 moderate trauma and 12 ITF samples). We first identified 31 lipids that were elevated and 6 lipids that were decreased in the more severe trauma group in aged patients, with an especially strong relationship among 14 lipids that are candidates as markers for trauma severity evaluation. Fourteen lipids were identified as potential markers of bone trauma. The definition of important lipids in trauma may not only provide guidance for the formulation of optimum ITF operation time, but may also have importance in other traumatic models, and in further understanding the components of the systemic inflammatory response for new drug targets.

Trauma in pregnancy: An analysis of the adverse perinatal outcomes and the injury severity score.

Trauma during pregnancy is one of the most important causes of non-obstetric maternal and fetal mortality and morbidity. The aim of our study is to evaluate the adverse perinatal outcomes that may occur according to the type and severity of the trauma. In this retrospective cohort study, pregnant traumatized women aged 18-50 years and referred for consultation to the Prof. Dr. Cemil Tascıoglu City Hospital's emergency services of the departments of gynecology and obstetrics, between January 1, 2017, and December 31, 2022, were evaluated. Demographic characteristics, trauma findings, Injury Severity Scoring (ISS), and obstet-ric outcomes were recorded. A total of 1825 trauma patients, including 900 pregnants were referred to our emergency gynecology clinic for consulta-tion. One hundred and fifty three pregnant patients, whose birth information we reached, were selected as the study group. The mean age of the patients was 25.56±5.99 years and the mean gestational week at the time of trauma was 21.59±9.89 weeks, the patients had fallen (67.97%), had been exposed to violence (30.07%), and had a traffic accient (1.96%). The patient's delivery and hospitalization status on the day of trauma, fracture and ISS ≥9 were statistically significantly at a higher rate in the 3rd trimester. Rates of hospitaliza-tion and 3rd trimester traumas were found to be significantly higher in the ISS ≥9 group. (P=0.0001, P=0.028, respectively). Compared to the general population, the rates of preterm premature rupture of membranes-premature rupture of membranes, fetal death, fetal distress, cesarean delivery, placental abruption, and preterm delivery increased in traumatized pregnant women. Patients with low ISS scores should also be followed closely during pregnancy in terms of perinatal complications, as well as the severe trauma group.

Influence of coronavirus disease 2019 case surges on prehospital emergency medical service for patients with trauma in Kobe, Japan.

In the current era of the coronavirus disease 2019 (COVID-19) pandemic, the responsiveness of emergency medical service (EMS) transport for patients with internal illness is often delayed. However, the influence of the COVID-19 pandemic on prehospital transport for patients with trauma has not yet been fully elucidated. This study aims to examine the effect of COVID-19 case surges on EMS transport for patients with trauma during the COVID-19 states of emergency in Kobe, Japan. EMS data during the states of emergency were compared with those in the 2019 prepandemic period. The incidence of difficulty securing hospital acceptance (four or more calls to medical institutions and ambulance staying at the scene for 30 min or more) was evaluated as a primary outcome. Secondary outcomes were the time spent at the trauma scene and the number of calls requesting hospital acceptance. The time spent at the trauma scene was stratified by trauma severity. The incidence of difficulty securing hospital acceptance increased (1.2% versus 3.2%, P < 0.01). Logistic regression analysis revealed that the duration of the states of emergency was associated with difficulty securing hospital acceptance (odds ratio [OR] 2.08, 95% confidence interval 1.77-2.45; P < 0.01). Although the mean time spent at the trauma scene among the less severe, moderately severe, and severe trauma groups was prolonged, the time for the life-threatening group did not change. The number of request calls increased during the states of emergency. Difficulty securing hospital acceptance increased; however, the time spent at the trauma scene did not significantly change for the life-threatening group.

Efficacy assessment of laser Doppler imager in diagnosing the pulp vitality after dental trauma

Background/purposeThis is the first paper evaluating the efficacy of laser Doppler imager in diagnosis of pulpal vitality. The purpose of this study was to evaluate and compare the diagnostic benefits of laser Doppler imaging and electric pulp test (EPT) in dental trauma. Materials and methodsSeven patients were selected for pulp vitality evaluation in Kaohsiung Medical University Hospital between 2018 and 2019. EPT and laser Doppler imager evaluation were performed for patients with traumatic injury to teeth. Statistical methods included the Kappa consistency test and the chi-square test. In addition, the receiver operating characteristic (ROC) curve, and the area under the curve (AUC) were used. ResultsThere was a significant difference in Doppler flow values between the severe trauma group and the mild trauma group, regardless of patient self-reported symptoms (P = 0.043) or physicians’ diagnostic classification (P = 0.018). For an EPT instrument, the Kappa coefficient was 0.67 and 1-year pulpal status findings were highly consistent (P < 0.001). Using a Doppler instrument, the Kappa coefficient was 0.85. According to the ROC curve, the AUC for EPT was 0.94, the AUC for Doppler was 1, and the optimal cut-off value was 31.55, indicating that both were superior diagnostic tools. ConclusionBoth laser Doppler imager and EPT can be used as tools for diagnosing traumatic pulp necrosis. Doppler imaging instruments allow for a more timely and accurate assessment of pulp vitality in dental trauma. In the future, ongoing research and related training are necessary for interpretation of Doppler data.

Typology of Traumatic Events and Physical Function

Individuals experience various traumatic events over the life course, but little is known about the patterns of lifetime exposure to traumatic events. This study aims to identify traumatic event typology and examine its relationship with physical function. Data were from the 2017-2019 PINE study (N= 3,125). Traumatic events were evaluated by earthquake, typhoon, tornado, residential fire, physical assault, robbery, sexual assault, divorce, bereavement, cancer, homeless, imprisonment, and falsely accused. Physical function was measured by activities of daily living (ADL), with lower scores indicating better physical function. Analysis was conducted using latent class analysis and the four-class model fits the data best. We identified four typologies: limited trauma, severe trauma, natural disaster, and mild-to-moderate trauma. The “limited trauma” (33.8%) has the lowest exposure to all traumatic events except typhoon and homeless. In contrast, an equivalent “severe trauma” (33.3%) has the highest exposure to all traumatic events except natural disasters. A small “natural disaster” (4.8%) has the highest exposure to natural disaster and moderate exposure to other traumatic events. The “mild-to-moderate trauma” (28.2%) has mild-to-moderate trauma exposures. The mild-to-moderate trauma group (M=0.38, SD=2.12) has better physical function than limited trauma (M=0.69, SD=3.08), severe trauma (M=0.61, SD=2.81), and natural disaster (M=0.71, SD=3.22) groups. After controlling confounding variables, the mild-to-moderate trauma group has lower risks of ADL impairment than the limited trauma group (OR=0.66, 95%CI=0.47-0.93). The findings suggest mild-to-moderate exposure to traumatic events might benefit older adults’ health, while limited trauma might not be able to develop resilience and severe trauma overwhelms coping strategies.

Complex childhood trauma, gender and depression: Patterns and correlates of help-seeking and maladaptive coping

BackgroundLittle is known about access to treatment or maladaptive coping amongst those with a history of childhood trauma and subsequent depressive disorder, which is often complicated by post traumatic stress disorder (PTSD). AimsTo (1) identify profiles of complex childhood trauma amongst men and women with major depression, (2) examine patterns of service access and treatment or maladaptive coping (drug misuse, alcohol abuse or suicidality), and (3) associations with socio-economic/demographic characteristics, comorbid PTSD, anxiety/mood disorders and perceived social support. MethodAnalysis of Wave 3 of the national epidemiologic survey on alcohol and related conditions (NESARC) (2012‐2013). We use the Latent Class Analysis 3-step approach in Mplus to examine individual differences in childhood experiences and coping behaviour. We examined both (a) the inter-relationship of this patterning, and (b) the extent to which proactive and maladaptive coping are associated with socio-economic/demographic characteristics, comorbid PTSD, anxiety disorders and perceived social support. Resultsa diagnosis of Major Depression was recorded for 7432 people, two thirds of whom reported a history of complex childhood trauma. Maladaptive coping is associated with the most severe trauma groups, comorbid PTSD, dysthymia, and anxiety disorders. ConclusionGiven the evidence of the current study, suggesting a poorer treatment course for depression in adults with complex childhood trauma, early screening for a trauma history will facilitate preventive efforts before onset of depression, possibly mitigating a poorer treatment course.

An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity.

BackgroundRapid identification of trauma severity is essential for the timely triage of multiple trauma patients. Tools such as the modified early warning score (MEWS) are used for determining injury severity. Although the conventional MEWS is a good predictor of mortality, its performance assessing injury severity is moderate. This study hypothesized that adding an injury site severity-related score (e.g., abdomen score) may enhance the capability of the MEWS for identifying severe trauma.MethodTo validate the hypothesis, we propose an improved modified early warning score called MEWS-A, which incorporates an injury site-specific severity-related abdomen score to MEWS. The utility of MEWS and MEWS-A were retrospectively evaluated and compared for identifying trauma severity in adult multiple trauma patients admitted to the emergency department.ResultsWe included 1,230 eligible multiple trauma patients and divided them into minor and severe trauma groups based on the injury severity score. Results of logistic regression and receiver operating characteristic (ROC) curve analyses showed that the MEWS-A had a higher area under the ROC curve (AUC: 0.81 95% CI [0.78–0.83]) than did the MEWS (AUC: 0.77 95% CI [0.74–0.79]), indicating that the MEWS-A is superior to the MEWS in identifying severe trauma. The optimal MEWS-A cut-off score is 4, with a specificity of 0.93 and a sensitivity of 0.54. MEWS-A ≥ 4 can be used as a protocol for decision-making in the emergency department.ConclusionsOur study suggests that while the conventional MEWS is sufficient for predicting mortality risk, adding an injury site-specific score (e.g., abdomen score) can enhance its performance in determining injury severity in multiple trauma patients.

Epidemiologic Features of Distal Radius Fractures in Severe Trauma Patients at the Busan Regional Trauma Center

Purpose: Distal radius fractures (DRFs) are often observed in simple trauma in older women with osteoporosis, and severe trauma caused by traffic or fall accidents. In this study, we aim to classify the DRFs according to injury mechanism, and statistically compare epidemiologic factors, radiological characteristics, and functional scores.Methods: From 2013 to 2018, 112 cases of trauma in 104 patients (70 monotrauma and 42 severe traumas) diagnosed with DRFs were included. Patients were divided into the low-energy monotrauma (ML), high-energy monotrauma (MH), and severe trauma (ST) groups and analyzed for differences in sex, Injury Severity Score (ISS), accompanying ipsilateral injuries, radiologic indices, AO classification, and functional outcome scores (disabilities of the arm, shoulder, and hand and Modified Mayo Wrist Score). Results: Significant differences were observed in sex, age, ISS, and accompanying ipsilateral injury among three group (p &lt; 0.001). Distribution of AO classification was not significantly different among the groups. Especially, sex, age, and accompanying ipsilateral injury were significantly different between the ML and MH groups (p&lt;0.001). postoperative DASH and MMWS were significantly different between the mono- and severe trauma groups (p&lt;0.001).Conclusions: Severe trauma with DRFs was observed at a lower age and more frequently accompanied by ipsilateral injury and high ISS. Additionally, the functional outcomes were lower after severe trauma than after monotrauma. Therefore, for DRF patients with severe trauma, attention should be paid to the pattern of fracture as well as the accompanying injury and postoperative management and rehabilitation associated with it.

Serum levels of NLRP3 and HMGB-1 are associated with the prognosis of patients with severe blunt abdominal trauma

OBJECTIVES:To investigate the relationship between the serum levels of NLRP3 and HMGB-1 and the prognosis of patients with severe blunt abdominal trauma.METHODS:In total, 299 patients were included in the current study from July 2014 to December 2015. All patients were divided into the mild/moderate blunt abdominal trauma group and the severe blunt abdominal trauma group according to their injury severity scores. Serum levels of NLRP3 and HMGB-1 were measured upon admission (0 h) and at 12 h, 24 h, 48 h, 72 h and 7 days after admission.RESULTS:Compared with the healthy controls, both the mild/moderate and severe blunt abdominal trauma groups had higher serum levels of NLRP3 and HMGB-1 at admission. At all points, the serum levels of NLRP3 and HMGB-1 were significantly higher in the severe group than in the mild/moderate group. The serum levels of both NLRP3 and HMGB-1 were significantly higher in the deceased patients than in the living patients. The Kaplan-Meier curve showed that compared with patients with higher levels of NLRP3 or HMGB-1, those with lower levels had longer survival times. The serum levels of both NLRP3 and HMGB-1 were independent risk factors for 6-month mortality in severe blunt abdominal trauma patients.CONCLUSION:The serum levels of NLRP3 and HMGB-1 were significantly elevated in severe blunt abdominal trauma patients, and the serum levels of both NLRP3 and HMGB-1 were correlated with 6-month mortality in severe blunt abdominal trauma patients.

Traumatisme et grossesse : le test de Kleihauer est-il vraiment utile ?

ObjectiveTo evaluate the pertinence of Kleihauer-Betke (KB) test, in case of abdominal trauma during pregnancy in forecast of fetal outcomes, according to trauma severity. MethodsA single-center retrospective study conducted between January 2014 and April 2016 in a maternity type III and a trauma center, which included the pregnant women admitted for abdominal trauma. The trauma's severity was assessed using the guidelines of the Society of Obstetricians and Gynaecologists of Canada. The impact of a positive KB test, defined as>0.1%, was analyzed. Adverse outcome was defined as one or more of the following complications: intrauterine fetal death, placental abruption, pre-term birth<37 weeks of gestation, and fetal or neonatal anemia. ResultsDuring the study period, 265 pregnancies involved into an abdominal trauma were included: 69% with a minor trauma and 31% with a severe trauma. Of all patients, 5.6% presented a positive KB test, among then 15.4% had an adverse outcome. There was no significant difference in the rate of adverse outcomes in the positive KB group and the KB negative group either in the overall population (P=0.16), in the minor trauma population (P=1) or in the major trauma population (P=0.14). The predictive positive values were respectively in the global population, in the minor trauma group and in the severe trauma group 15.4%, 0% and 25%. ConclusionsThe KB test does not seem to be useful in case of trauma during pregnancy to define adverse outcome.

Activation of the protein C pathway and endothelial glycocalyx shedding is associated with coagulopathy in an ovine model of trauma and hemorrhage.

Acute traumatic coagulopathy (ATC) is an endogenous coagulopathy that develops following tissue injury and shock. The pathogenesis of ATC remains poorly understood, with platelet dysfunction, activation of the protein C pathway, and endothelial glycocalyx shedding all hypothesized to contribute to onset. The primary aim of this study was to develop an ovine model of traumatic coagulopathy, with a secondary aim of assessing proposed pathophysiological mechanisms within this model. Twelve adult Samm-Border Leicester cross ewes were anesthetized, instrumented, and divided into three groups. The moderate trauma group (n = 4) underwent 20% blood volume hemorrhage, bilateral tibial fractures, and pulmonary contusions. The severe trauma group (n = 4) underwent the same injuries, an additional hamstring crush injury, and 30% blood volume hemorrhage. The remaining animals (n = 4) were uninjured controls. Blood samples were collected at baseline and regularly after injury for evaluation of routine hematology, arterial blood gases, coagulation and platelet function, and factor V, factor VIII, plasminogen activator inhibitor 1, syndecan 1, and hyaluranon levels. At 4 hours after injury, a mean increase in international normalized ratio of 20.50% ± 12.16% was evident in the severe trauma group and 22.50% ± 1.00% in the moderate trauma group. An increase in activated partial thromboplastin time was evident in both groups, with a mean of 34.25 ± 1.71 seconds evident at 2 hours in the severe trauma animals and 34.75 ± 2.50 seconds evident at 4 hours in the moderate trauma animals. This was accompanied by a reduction in ROTEM EXTEM A10 in the severe trauma group to 40.75 ± 8.42 mm at 3 hours after injury. Arterial lactate and indices of coagulation function were significantly correlated (R = -0.86, p < 0.0001). Coagulopathy was also correlated with activation of the protein C pathway and endothelial glycocalyx shedding. While a significant reduction in platelet count was evident in the severe trauma group at 30 minutes after injury (p = 0.018), there was no evidence of altered platelet function on induced aggregation testing. Significant fibrinolysis was not evident. Animals in the severe trauma group developed coagulation changes consistent with current definitions of ATC. The degree of coagulopathy was correlated with the degree of shock, quantified by arterial lactate. Activation of the protein C pathway and endothelial glycocalyx shedding were correlated with the development of coagulopathy; however, altered platelet function was not evident in this model.

Serum interleukin-6 level as an early marker of injury severity in trauma patients in an urban low-income setting: a cross-sectional study.

BackgroundTrauma is still the leading cause of death in many regions of the world. Severity scores have been developed to assist in management of trauma victims. Immune response to trauma has been known to positively correspond to the severity of trauma. Part of this response involves release of cytokines into blood circulation which promote the acute inflammatory response commonly seen after trauma. Studies have shown that IL-6 levels commonly correlate positively with the Injury Severity Score (ISS). The aim of this cross-sectional study was to determine whether this kind of relationship exists between IL-6 levels and injury severity in trauma patients in Mulago Hospital as defined by the Kampala Trauma Score (KTSII) which is locally developed.MethodsTrauma patients aged ≥18 years presenting to the Accident and Emergency unit of Mulago National Referral Hospital (MNRH) within 12 h after injury were recruited into the study after obtaining consent. Severity of injury was determined as per the Kampala Trauma Score (KTSII) and venous blood drawn for assay of serum IL-6 levels. Data obtained was entered and analyzed using Stata version 11 software focusing on the association between Serum IL-6 levels with Severity of trauma and duration of injury.ResultsA total of 159 patients were recruited (79 Mild and 80 Severe trauma) with a male to female ratio of 4.7:1. Road traffic crashes (67.92 %) were the commonest cause of injury. Serum IL-6 levels were found to positively correspond with severity of injury (z = 4.718, p < 0.001). There was no significant correlation between serum IL-6 levels and duration of injury in both severe (r = 0.12, p = 0.29) and mild (r = 0.06, p = 0.62) trauma groups of patients. Only 9.43 % of trauma patients were brought in an Ambulance.ConclusionsSerum IL-6 levels correspond with severity of injury. However, within the first twelve hours after injury, these levels did not vary significantly with duration of injury.

Is Routine Repeated Head CT Necessary for All Pediatric Traumatic Brain Injury?

ObjectiveRepeated computed tomography (CT) follow up for traumatic brain injury (TBI) patients is often performed. But there is debate the indication for repeated CT scans, especially in pediatric patients. Purpose of our study is to find risk factors of progression on repeated CT and delayed surgical intervention based on the repeated head CT.MethodsBetween March, 2007 and December, 2013, 269 pediatric patients (age 0-18 years) had admitted to our hospital for head trauma. Patients were classified into 8 subgroups according to mechanisms of injury. Types, amount of hemorrhage and amount changes on repeated CT were analyzed as well as initial Glasgow Coma Scale (GCS) scores.ResultsWithin our cohort of 269 patients, 174 patients received repeat CT. There were progression in the amount of hemorrhage in 48 (27.6%) patients. Among various hemorrhage types, epidural hemorrhage (EDH) more than 10 cc measured in initial CT was found to be at risk of delayed surgical intervention significantly after routine repeated CT with or without neurological deterioration than other types of hemorrhage. Based on initial GCS, severe head trauma group (GCS 3-8) was at risk of delayed surgical intervention after routine repeated CT without change of clinical neurologic status.ConclusionWe suggest that the patients with EDH more than 10 cc or GCS below 9 should receive repeated head CT even though absence of significant clinical deterioration.

Which Biomarker is most Effective to Determine Severity of Acute Head Trauma in the Experimental Animal Head Trauma Model?

Because of the need for effective method to determine the severity of head trauma, the importance of biomarkers is recognized recently. This study aims to analyze the values of sera levels of some biomarkers and the relation with their tissue levels in acute head injury. In this study, rats were divided into three groups (mild head trauma, severe head trauma and control group). All rats were anaesthetized. Weightdrop method was used as trauma method. Blood samples were obtained five minutes after trauma when the acute effects of trauma occurred. Then whole brains of rats were excised. Levels of biomarkers were investigated in the sera samples and homogenized brain tissues biochemically. Significant differences in the sera GFAP (p=0.015) and insulin (p=0.011) levels were observed. Very significant difference in the sera nNOS level was observed. Extremely significant difference in the tissue IL-6 (p < 0.001) level was observed between all groups. Sera nNOS and tissue IL-6 are the best biomarkers to predict trauma severity. Sera GFAP and insulin are also capable to show trauma severity in the very acute period of postinjury. Tissue levels of the biomarkers except insulin are higher than their sera levels.

Association of traumatic severity with change in lymphocyte subsets in the early stage after trauma

To investigate the association of traumatic severity with changes in lymphocyte subsets in the early stage after trauma. Sixty-three male patients admitted within 4 hours after trauma were enrolled. According to injury severity score (ISS), the patients were divided into two groups: mild trauma group (ISS<16, n=35) and severe trauma group (ISS≥16, n=28). At admission, the patients peripheral blood were extracted to detect T lymphocytes subsets, blood routine test, blood biochemical and arterial blood gas analysis which were used to calculate the acute physiology and chronic health evaluation II (APACHEII) scores. The correlation of lymphocyte subsets and ISS score, and the correlation of lymphocyte subsets and APACHEII score were both analyzed statistically. Another 20 cases of healthy male adults were enrolled as the control group. Compared with the healthy control group, CD3(+) T cell contents in blood were decreased obviously in mild trauma group and severe trauma group (0.648±0.112, 0.647±0.110 vs. 0.708±0.082, both P<0.05); CD4(+) T cells contents in severe group were decreased significantly (0.317±0.086 vs. 0.389±0.064, P<0.05), and natural killer (NK) cells were significantly increased (0.217±0.107 vs. 0.158±0.068, P<0.05). B cells content in severe group was decreased significantly than that of mild group (0.114±0.060 vs. 0.155±0.075, P<0.05). There were no significant difference in CD8(+) and CD4/CD8 ratio among the healthy control group, mild trauma group and severe trauma group (CD8(+): 0.260±0.074, 0.260±0.091, 0.271±0.105; CD4/CD8 ratio: 1.69±0.75, 1.56±0.83, 1.34±0.65, all P>0.05). Except that there were negative correlation between CD3(+) T cells and the ISS scores (r=-0.42, P=0.03), the other lymphocyte subsets showed no correlation with the ISS scores and the APACHEII scores (mild trauma group with ISS scores: CD3(+) r=-0.10, CD4(+) r=-0.31, CD8(+) r=0.18, B cells r=0.20, NK cells r=-0.04; mild trauma group with APACHEII scores: CD3(+) r=0.04, CD4(+) r=-0.07, CD8(+) r=0.06, B cells r=-0.10, NK cells r=0.05, severe trauma group with ISS scores: CD4(+) r=-0.12, CD8(+) r=-0.17, B cells r=0.02, NK cells r=0.31,all P>0.05;severe trauma group with APACHEII scores:CD3(+) r=-0.24, CD4(+) r=0.11, CD8(+) r=-0.26, B cells r=0.15, NK cells r=0.08, all P>0.05). CD3(+) and CD4(+) T cells decreased and NK cells increased significantly in blood in the early stage after severe trauma. CD3(+) T cells are independent indexes which reflect body injury. Therefore, it is necessary to monitor the changes of immune cells dynamically after severe trauma.

Detection of cerebral spinal fluid‐associated chemokines in birth traumatized premature babies by chip‐based immunoaffinity CE

A major concern in treating premature infants with birth-associated head trauma is the rapid determination of reliable biomarkers of neuroinflammation. To this end a chip-based immunoaffinity CE device has been applied to determine the concentrations of inflammation-associated chemokines in samples of cerebral spinal fluid collected from such subjects. The chip utilizes replaceable immunoaffinity disks, to which reactive antibody fragments (FAb) of six antichemokine-specific antibodies were immobilized. Following injection of a sample into the device, the analytes were captured by the immobilized FAbs, labeled in situ with a red laser dye, chemically released and separated by CE. Each resolved peak was measured on-line by LIF detection and the results compared to standard curves produced by running known chemokine standards through the immunoaffinity system. The complete processing of a sample took 10 min with separation of all six analytes being achieved in less than 2 min. The system compared well to commercial ELISA, analysis of the results by linear regression demonstrating r(2) values in the range of 0.903-0.978, and intra and interassay CV of the migration times and the measured peak areas being less than 2.3 and 5%, respectively. Application of the system to analysis of cerebrospinal fluid from head traumatized babies clearly indicated the group with mild trauma versus those with severe injury. Additionally, CE analysis demonstrated that the severe trauma group could be divided into individuals with good and poor prognosis, which correlated with the clinical finding for each patient.

The role of neuropeptide Y and aquaporin 4 in the pathogenesis of intestinal dysfunction caused by traumatic brain injury

BackgroundAlthough the exact incidence is unknown, traumatic brain injury (TBI) can lead to intestinal dysfunction. It has important influence on the early nutrition and prognosis of TBI patients. Experiments were designed to study the roles of neuropeptide Y (NPY) and aquaporin 4 (AQP4) in the pathogenesis of intestinal dysfunction caused by TBI and to find some new solutions for the treatment of intestinal dysfunction after TBI. MethodsForty adult male Wistar rats were randomly divided into control, mild trauma, moderate trauma, and severe trauma groups. TBI was induced by Feeney's impact method. Control animals were sham operated but not subjected to the impact test. All rats were killed 24 h after surgery. Blood samples were obtained from the abdominal aorta for enzyme-linked immunosorbent assay measurement of NPY concentrations. Jejunum segments 15 cm distal to the Treitz ligament were taken for analysis of NPY and AQP4 expression by polymerase chain reaction, Western blot, and immunohistochemistry. Pathologic changes in intestinal cell structure and ultrastructure were studied by light microscopy and transmission electron microscopy. ResultsThe specimens from different groups showed different degrees of structural changes, ranging from swelling and degeneration of villous epithelial cells to extensive denudation and collapse of the villi. The more severe the trauma, the more serious the degree of intestinal mucosal injury. Intestinal smooth muscle also showed varying degrees of edema and structural disorder. Electron microscopy showed that intestinal mitochondria had varying degrees of swelling and the structure of mitochondrial crista was disordered and even fractured. Plasma concentrations of NPY and jejunal gene and protein expressions of NPY and AQP4 increased significantly following TBI (P < 0.05), with greater increases at higher levels of injury. Moreover, there were positive correlations between NPY and AQP4 (P < 0.05). ConclusionsIncreasing grades of TBI caused increasing degrees of intestinal ischemia and edema, and thus caused increasingly severe intestinal dysfunction. AQP4 and NPY may be involved in the pathogenesis of intestinal dysfunction after TBI. Increased NPY levels may be responsible for intestinal ischemia and hypoxia, and AQP4 may play an important role in intestinal edema. Increased NPY levels may be one of the main causes for the increase in AQP4 after TBI.

Early changes of plasma levels of angiopoietin-2 in multiple trauma patients and the relationship between endothelial injury, prognosis

Objective To investigate the early changes of plasma levels of angiopoietin2 in patients with multiple trauma and the relationship between plasma levels of angiopoietin2 (Ang2) and endothelial injury as well as prognosis of patients in order to determine their clinical significance. Methods Patients with multiple trauma admitted to emergency department from January 2008 to January 2010 were enrolled. A total of 59 casualties met the criteria(admission within 1 h after trauma and age > 18 years), and were eligible for enrollment. Patients with heart, brain, liver, kidney and other organic diseases, diabetes, hypertension, tumor, acute and chronic infectious diseases , severe brain injury (CCS 18 years and an average age of(33.5 ±10.6) years. All groups had comparable gender proportion and average age. The 10 mL peripheral blood sanple was collected within 10 minutes after arrival of patients to emergency department and the plasma was separated from blood. Enzyme-linked immunosorbent assay (ELISA) was used to detect the plasma levels of angiopoietin2, and the plasma levels of von Willebrand factor (vWF) and thrombomodulin (TM) were also detected. Data were expressed as mean ± standard deviation and were statistically analyzed by using SPSS version 13.0 statistical software. The differences in plasma levels of angiopoietin2 of patients in each group were analyzed by ANOVA and Newman-Keuls test. Levels of angiopoietin2 in fatal patients and survival patients were also compared by using t test. The relationships between angiopoietin2 and plasma levels of vWF as well as levels of TM were analyzed by Pearson correlation analysis. Changes were considered as statistically significant if P value was less than 0.05. Results The plasma levels of angiopoietin2 in severe trauma group (ISS scored 16 points) were significantly higher than those in moderate trauma group (ISS < 16 points) ( P < 0.05 ), and those in trauma patients of the two groups were both significantly higher than those in control group (P < 0.05). The plasma levels of angiopoietin2 in fatal patients were significantly higher than those in survivors (P < 0.05). Plasma levels of angiopoietin2 were significantly correlated with plasma levels of vWF and TM (P < 0.05). Conclusions The plasma levels of angiopoietin-2 significantly increase after multiple trauma, and correlate with the degree of trauma severity. The plasma levels of angiopoietin2 correlate with endothelial injury after multiple trauma, having important prognosis value in patients with multiple trauma. Key words: Multiple trauma; Angiopoietin2; Endothelial injury; Prognosis

Correlation between timing of trauma in living individuals and plasma level of soluble intercellular adhesion molecule type-1 (sICAM-1)

AimThe aim of the present study is to correlate between the level of the soluble intercellular adhesion molecule type-1 (sICAM-1) and the timing of trauma in living individuals. MethodologyThirty patients were divided, according to the degree of injury severity score (ISS), into three equal groups: mild, moderate, and severe trauma groups. According to sampling time, samples from each group were further subdivided, into three subgroups, within the first 24h of admission, on the third day, and on the fifth day of admission. The level of sICAM-1 was measured in plasma using the ELISA technique in relation to the time passed since infliction of injury. The control group followed the same order of sampling. Many factors were studied in the current study such as sex, nature of injury, associated severe head injuries, and the combining bone and soft tissue affection. ResultsA significant increase was noticed in all subgroups when compared with the control group. A characteristic pattern of sICAM-1 variation with the timing of wounds was at its maximum level on the third day post-trauma and then decreases toward its normal level. This pattern was only affected by the severity of injury with a directly proportional relationship. RecommendationsWe recommend the forensic use of sICAM-1 in the estimation of the timing of trauma in living individuals, especially in cases of doubtful circumstances of trauma or suspected abuse or torture, which will improve the wound age assessment and enforce the probability testing by experts.