Home About us Contact
|
Home About us Contact | ||
|
|
||
Injury Scores (injury + score)
Selected AbstractsIntestinal-FABP and Liver-FABP: Novel Markers for Severe Abdominal InjuryACADEMIC EMERGENCY MEDICINE, Issue 7 2010Borna Relja MSc ACADEMIC EMERGENCY MEDICINE 2010; 17:729,735 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, Fatty acid,binding proteins (FABPs) have relatively high tissue concentrations and low plasma concentrations and are released into the circulation following organ injury. We explored the utility of intestinal-(I)-FABP and liver-(L)-FABP for the diagnosis of abdominal injury in patients with multiple trauma. Methods:, This prospective study included 102 trauma patients and 30 healthy volunteers. Plasma I-FABP and L-FABP levels were measured in the emergency department (ED) by enzyme-linked immunosorbent assay (ELISA). Forty-one patients suffered from serious or severe abdominal trauma (Abbreviated Injury Score [AIS] code "ai" for abdominal injury, AISai , 3) and nine were moderately abdominally injured (AISai < 3). Fifty-two had no abdominal injury. Results:, Median I-FABP and L-FABP levels in the AISai , 3 group (516 pg/mL and 135 ng/mL, respectively) were significantly higher compared to the AISai < 3 group (154 pg/mL and 13 ng/mL, respectively) or those without abdominal injury (207 pg/mL and 21 ng/mL, respectively) or normal controls (108 pg/mL and 13 ng/mL, respectively). The cutoff to distinguish the ai , 3 is 359 pg/mL for I-FABP and 54 ng/mL for L-FABP, with 93% specificity and 75% sensitivity for I-FABP and 93% and 82% for L-FABP, respectively. Conclusions:, High I-FABP and L-FABP levels correlate with relevant severity of abdominal tissue damage in patients with multiple trauma. I-FABP and L-FABP could be useful as markers for the early detection of significant abdominal injury in acute multiple trauma and identify patients who require rapid intervention. [source] Gliotoxin, an inhibitor of nuclear factor-kappa B, attenuates peptidoglycan-polysaccharide-induced colitis in ratsINFLAMMATORY BOWEL DISEASES, Issue 3 2002Dr. Leo R. Fitzpatrick Abstract Gliotoxin is a fungal metabolite that has immunosuppressive properties. First, we determined if gliotoxin could inhibit bacterial peptidoglycan,polysaccharide-stimulated tumor necrosis factor-, production, as well as nuclear factor-kappa B (NF-,B), in a rat macrophage (NR8383) cell line. Next, the apoptosis-inducing potential of gliotoxin was also evaluated in this cell line. Finally, we evaluated whether gliotoxin could reduce peptidoglycan,polysaccharide-induced colitis in rats. Gliotoxin (2 mg/kg/day) was dosed from day 14 after the initial intramural colonic injection of peptidoglycan,polysaccharide until day 21. A gross colonic injury score, myeloperoxidase activity, and cytokine levels were all evaluated on day 21. Gliotoxin dose dependently inhibited cytokine production, as well as NF-,B, and also induced apoptosis in the NR8383 cell line. On day 21, gliotoxin significantly reduced gross colonic injury (adhesions, nodules, mucosal lesions) in rats. Gliotoxin-treated rats also had partially normalized biochemical indices of colitis, such as colonic cytokine levels. The colonic level of NF-,B was also partially normalized in gliotoxin treated rats. Gliotoxin also exhibited an antiarthritis effect in peptidoglycan,polysaccharide-treated rats. In summary, gliotoxin effectively attenuated the chronic reactivation phase of peptidoglycan,polysaccharide-induced colitis. This anticolitis effect may be related to the inhibition of NF-,B in Lewis rats. [source] Nerve perforation with pencil point or short bevelled needles: histological outcomeACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010T. STEINFELDT Background: In the case of needle nerve contact during peripheral blocks, pencil point needles are considered less traumatic compared with bevelled needles. However, there are not enough data to prove this notion. Therefore, the aim of this study was to challenge the hypothesis that nerve perforation with short bevelled needles is associated with major nerve damage compared with pencil point needles. Methods: In five anaesthetised pigs, the brachial plexus was exposed bilaterally. Up to eight nerves underwent needle nerve perforation using a pencil point needles cannula or an short bevelled needle. After 48 h, the nerves were resected. The specimens were processed for visual examination and the detection of inflammatory cells (haematoxylin,eosin, i.e. CD68-immunohistochemistry to detect macrophages), myelin damage (Kluver,Barrera staining) and intraneural haematoma. The grade of nerve injury was characterised by an objective score ranging from 0 (no injury) to 4 (severe injury). Results: Fifty nerves were examined. According to the injury score applied, there was no significant difference between the pencil point needles [median (inter-quartile range) 2.0 (2.0,2.0)] and the short bevelled-needle group [median 2.0 (2.0,2.0) P=0.23]. No myelin damage was observed. Signs of post-traumatic inflammation were equally distributed among both groups. Conclusions: In the present study, the magnitude of nerve injury after needle nerve perforation was not related to one of the applied needle types. Post-traumatic inflammation rather than structural damage of nerve tissue is the only notable sign of nerve injury after needle nerve perforation with either needle type. However, neither the pencil point- nor the short bevelled needle can be designated a less traumatic device. [source] Diagnosing acute lung injury in the critically ill: a national survey among critical care physiciansACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009A. P. J. VLAAR Background: Incidence reports on acute lung injury (ALI) vary widely. An insight into the diagnostic preferences of critical care physicians when diagnosing ALI may improve identification of the ALI patient population. Methods: Critical care physicians in the Netherlands were surveyed using vignettes involving hypothetical patients and a questionnaire. The vignettes varied in seven diagnostic determinants based on the North American European Consensus Conference and the lung injury score. Preferences were analyzed using a mixed-effects logistic regression model and presented as an odds ratio (OR) with a 95% confidence interval. Results: From 243 surveys sent to 30 hospitals, 101 were returned (42%). ORs were as follows: chest X-ray consistent with ALI: OR 1.7 (1.3,2.3), high positive end-expiratory pressure (PEEP) (15 cmH2O): OR 5.0 (3.9,6.6), low pulmonary artery occlusion pressures (PAOP) (<18 mmHg): OR 4.7 (3.6,6.1), low compliance (30 ml/cmH2O): OR 0.7 (0.5,0.9), low PaO2/FiO2 (<250 mmHg): OR 9.2 (6.9,12.3), absence of heart failure: OR 1.2 (0.9,1.5), presence of a risk factor for ALI (sepsis): OR 1.0 (0.8,1.3). The questionnaire revealed that critical care physicians with an anesthesiology background differed from physicians with an internal medicine background with regard to hemodynamic variables when considering an ALI diagnosis (P<0.05). Conclusions: Dutch critical care physicians consider the PEEP level, but not the presence of a risk factor for ALI, as an important factor to diagnose ALI. Background specialty of critical care physicians influences diagnostic preferences and may account for variance in the reported incidence of ALI. [source] The horse-racetrack interface: a preliminary study on the effect of shoeing on impact trauma using a novel wireless data acquisition systemEQUINE VETERINARY JOURNAL, Issue 7 2006B. L. DALLAP SCHAER Summary Reasons for performing study: There is a need to determine accelerations acting on the equine hoof under field conditions in order to better assess the risks for orthopaedic health associated with shoeing practices and/or surface conditions. Objectives: To measure the acceleration profiles generated in Thoroughbred racehorses exercising at high speeds over dirt racetracks and specifically to evaluate the effect of a toe grab shoe compared to a flat racing plate, using a newly developed wireless data acquisition system (WDAS). Methods: Four Thoroughbred racehorses in training and racing were used. Based on previous trials, each horse served as its own control for speed trials, with shoe type as variable. Horses were evaluated at speeds ranging from 12.0,17.3 m/sec. Impact accelerations, acceleration on break over and take-off, and temporal stride parameters were calculated. Impact injury scores were also determined, using peak accelerations and the time over which they occurred. Results: Recorded accelerations for the resultant vector (all horses all speeds) calculated from triaxial accelerometers ranged 96.3,251.1 g, depending on the phase of the impact event. An association was observed between shoe type and change in acceleration in individual horses, with 2 horses having increased g on initial impact with toe grab shoes in place. In the final impact phase, one horse had an increase of 110 g while wearing toe grab shoes. Increased accelerations were also observed on break over in 2 horses while wearing toe grab shoes. Conclusions: Shoe type may change impact accelerations significantly in an individual horse and could represent increased risk for injury. Further work is needed to determine if trends exist across a population. Potential relevance: The WDAS could be used for performance evaluation in individual horses to evaluate any component of the horse-performance surface interface, with the goal of minimising risk and optimising performance. [source] Not Another Formula for Heart Rate Correction of QT IntervalANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2009F.R.C.P., Peter J. Bourdillon M.B.B.S. Background: Normal limits for QT and heart rate were developed in a Japanese population undergoing 24 hour recordings of the electrocardiogram (ECG). The purpose of this study is to validate these normal limits in a West London population having 12-lead ECGs. Methods: A retrospective observational cohort of 10,099 patients aged 20,79 attending a hospital ECG department was studied. From the Japanese data z-scores were calculated for men under 50, for men over 50, for women under 50 and for women over 50. z-scores were used to compare the West London and Japanese populations. Results: Cardiac infarction injury scores (CIIS) for all four groups were less than zero indicating a population at low risk of cardiovascular disease. From the Japanese data a z-score of 1 is roughly 20 ms. West London mean (SD) z-scores for men under 50, for men over 50, for women under 50 and for women over 50 were 0.20 (0.85), ,0.02 (0.86), 0.14 (0.93), and ,0.45 (0.88), respectively. Conclusions: The distributions of the QT and heart rate data of a West London population at low risk of cardiovascular disease are comparable to the Japanese data. The Japanese QT normal limits for women over the age of 50 are about 9 ms higher regardless of heart rate. The QT normal limits for Afro-Caribbeans are about 5 ms lower than other ethnic groups. The Japanese normal limits are applicable elsewhere, albeit adjusting for women over the age of 50 and for Afro-Caribbeans. [source] Therapeutic Effects and Anti-inflammatory Mechanisms of Heparin on Acute Lung Injury in RabbitsACADEMIC EMERGENCY MEDICINE, Issue 7 2008Meitang Wang MD Abstract Objectives:, The objectives were to investigate the potential beneficial effects and molecular mechanisms of heparin and low-molecular-weight heparin (LMWH) on acute lung injury (ALI). Methods:, Forty-eight rabbits were randomized into four groups: normal control group (Group A), lipopolysaccharide (LPS) group (Group B), LPS + heparin group (Group C), and LPS + LMWH group (Group D). The rabbit ALI model was established by intravenous (IV) injection with LPS. Alveolar,arterial O2 difference (PA-aO2), serum tumor necrosis factor , (TNF-,), circulating p38 mitogen-activated protein kinase (p38 MAPK) levels, lung nuclear factor (NF)-,B levels, and lung dry/wet (D/W) ratio were measured, and the lung injury scores were calculated. Results:, Lipopolysaccharide caused significant increases in PA-aO2, serum TNF-,, expression of p38 MAPK in polymorphonuclear neutrophils (PMNs), the lung injury scores, and nuclear factor-,B (NF-,B) activity in the lung tissue and caused a decrease in lung D/W ratio. A positive linear correlation was found between p38 MAPK and TNF-, at 1, 2, 4, and 6 hours (r = 0.68, 0.92, 0.93, and 0.93, respectively) and between NF-,B and p38 MAPK and TNF-, at 6 hours (r = 0.94 and 0.83, respectively). IV heparin or LMWH given after LPS treatment attenuated these changes in inflammatory response, oxygenation, p38 MAPK expression, and NF-,B activation. Conclusions:, The anti-inflammatory mechanisms of heparin in ALI may be inhibiting p38 MAPK and NF-,B activities, and then TNF-, overexpression, thus alleviating the inflammatory reaction. [source] Hypertonic saline attenuates end-organ damage in an experimental model of acute pancreatitisBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2000C. J. Shields Background Hypertonic saline (HTS) has been noted previously to reduce neutrophil activation. The aim of this study was to elucidate the effect of hypertonic resuscitation on the development of end-organ damage in an animal model of pancreatitis. Methods Pancreatitis was induced in Sprague,Dawley rats by intraperitoneal injection of 20 per cent l -arginine. Animals were randomized into four groups (each n = 8): controls; pancreatitis without intervention; pancreatitis plus intravenous resuscitation with normal saline (0·9 per cent sodium chloride 2 ml/kg) at 24 and 48 h; or HTS (7·5 per cent sodium chloride 2 ml/kg) at these time points. Pulmonary endothelial leakage was assessed by measurement of lung wet: dry ratios, bronchoalveolar lavage protein and myeloperoxidase activity. Results Animals that received HTS showed less pancreatic damage than those resuscitated with normal saline (1·0 versus 3·0; P = 0·04). Lung injury scores were also significantly diminished in the HTS group (1·0 versus 3·5; P = 0·03). Pulmonary neutrophil sequestration (myeloperoxidase activity 1·80 units/g) and increased endothelial permeability (bronchoalveolar lavage protein content 1287 ,g/ml) were evident in animals resuscitated with normal saline compared with HTS (1·22 units/g and 277 ,g/ml respectively; P < 0·02). Conclusion HTS resuscitation results in a significant attenuation of end-organ injury following a systemic inflammatory response to severe pancreatitis. © 2000 British Journal of Surgery Society Ltd [source] | ||||||||||