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209
mitochondrial DAMPs cause inflammatory responses to injury. Nature
- Sursal T, JungerW, Brohi K, Itagaki K, Hauser C. Circulating
"... Injury causes a systemic inflammatory response syndrome (SIRS) clinically much like sepsis 1. Microbial pathogen-associated molecular patterns (PAMPs) activate innate immunocytes through pattern recognition receptors 2. Similarly, cellular injury can release endogenous damage-associated molecular pa ..."
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Injury causes a systemic inflammatory response syndrome (SIRS) clinically much like sepsis 1. Microbial pathogen-associated molecular patterns (PAMPs) activate innate immunocytes through pattern recognition receptors 2. Similarly, cellular injury can release endogenous damage-associated molecular patterns (DAMPs) that activate innate immunity 3. Mitochondria are evolutionary endosymbionts that were derived from bacteria 4 and so might bear bacterial molecular motifs. We show here that injury releases mitochondrial DAMPs (MTD) into the circulation with functionally important immune consequences. MTD include formyl peptides and mitochondrial DNA. These activate human neutrophils (PMN) through formyl peptide receptor-1 and TLR9 respectively. MTD promote PMN Ca2+ flux and phosphorylation of MAP kinases, thus leading to PMN migration and degranulation in vitro and in vivo. Circulating MTD can elicit neutrophil-mediated organ injury. Cellular disruption by trauma releases mitochondrial DAMPs with evolutionarily conserved similarities to bacterial PAMPs into the circulation. These can then signal through identical innate immune pathways to create a sepsis-like state. The release of such mitochondrial ‘enemies within ’ by cellular injury is a key link between trauma, inflammation and
Road traffic injuries in developing countries: a comprehensive review of epidemiological studies. Trop Med Int Health
, 1997
"... comprehensive review of epidemiological studies ..."
Trauma governance in the UK defence medical services. J Royal Army Med Corps 2007;153:239–42; discussion 243
"... Clinical governance is concerned with the application and enforcement of good clinical practice [1-4] and the management of military trauma patients is no exception. To this end, a framework of governance has been implemented to ..."
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Clinical governance is concerned with the application and enforcement of good clinical practice [1-4] and the management of military trauma patients is no exception. To this end, a framework of governance has been implemented to
Acinetobacter baumannii skin and soft-tissue infection associated with war trauma. Clin Infect Dis
, 2008
"... (See the article by Whitman et al. on pages 439–43) Background. Acinetobacter baumannii is usually associated with nosocomial pneumonia or bacteremia. Reports of A. baumannii skin and soft-tissue infection (SSTI) are uncommon. Methods. We performed a retrospective review of 57 inpatients admitted to ..."
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(See the article by Whitman et al. on pages 439–43) Background. Acinetobacter baumannii is usually associated with nosocomial pneumonia or bacteremia. Reports of A. baumannii skin and soft-tissue infection (SSTI) are uncommon. Methods. We performed a retrospective review of 57 inpatients admitted to a naval hospital ship and identified 8 patients with A. baumannii–associated SSTI. Demographic and clinical characteristics were compared between these patients and 49 patients with A. baumannii infections that were not SSTIs. We also reviewed 18 cases of A. baumannii–associated SSTI from the literature. Results. Our 8 cases of A. baumannii–associated SSTI were associated with combat trauma wounds. The median age of the patients was 26 years. Although not statistically significant, A. baumannii–associated SSTIs were more likely to be associated with gunshot wounds (75 % vs. 55%) or external fixators (63 % vs. 29%), compared with A. baumannii infections that were not SSTIs. Use of a central venous catheter and total parenteral nutrition was also more common for patients with SSTI. Our cases of A. baumannii–associated SSTI presented as cellulitis with a “peau d’orange ” appearance with overlying vesicles and, when untreated, progressed to necrotizing infection with bullae (hemorrhagic and nonhemorrhagic). In our case series, all isolates were multidrug resistant, and clinical success was achieved for 7 of 8 patients with debridement and carbapenem therapy.
Or i g i n a l Re s e a r c h Crash Injury Prediction and Vehicle Damage Reporting by Paramedics
, 2008
"... Reprints available through open access at www.westjem.org Objective: The accuracy of pre-hospital crash scene details and crash victim assessment has important implications for initial trauma care assessment and management. Similarly, it is known to influence physician perception of crash victim inj ..."
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Reprints available through open access at www.westjem.org Objective: The accuracy of pre-hospital crash scene details and crash victim assessment has important implications for initial trauma care assessment and management. Similarly, it is known to influence physician perception of crash victim injury severity. The goal of this feasibility study was to examine paramedic accuracy in predicting crash victim injury profile, disability outcome at hospital discharge, and reporting vehicle damage with other crash variables. Methods: This prospective case series study was undertaken at a Southern California, Level I trauma center certified by the American College of Surgeons. Paramedics transporting crash injured motor vehicle occupants to our emergency department (ED)/trauma center were surveyed. We abstracted ED and in-patient records of injured vehicle occupants. Vehicle and crash scene data were obtained from a professional crash reconstruction, which included the assessment of deformation, crash forces, change in velocity, and the source of each injury. Results: We used survey, injury, and crash reconstruction data from 22 collision cases in the final analysis. The median Injury Severity Score (ISS) was five (range 1-24). No enrolled patients died, and none were severely disabled at the time of discharge from the hospital. The paramedic crash
Naredi S: Severe traumatic brain injury: consequences of early adverse events
- Acta Anaesthesiol Scand
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, 2013
"... This Provisional PDF corresponds to the article as it appeared upon acceptance. Copyedited and fully formatted PDF and full text (HTML) versions will be made available soon. Assessment and clinical course of hypocalcemia in critical illness ..."
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This Provisional PDF corresponds to the article as it appeared upon acceptance. Copyedited and fully formatted PDF and full text (HTML) versions will be made available soon. Assessment and clinical course of hypocalcemia in critical illness
Prediction of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury,”Disability and Rehabilitation
, 2006
"... Purpose. To examine predictors of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury (TBI). Method. This study involved analysis of data from a retrospective cohort of adults (N = 306) with moderate to severe TBI discharged from a Pennsylvania reha ..."
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Purpose. To examine predictors of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury (TBI). Method. This study involved analysis of data from a retrospective cohort of adults (N = 306) with moderate to severe TBI discharged from a Pennsylvania rehabilitation treatment facility. Extensive pre-injury sociodemographic, injury-severity, post-injury personal (cognitive, physical, affective), post-injury environmental (social, institutional, physical), and post-injury occupational performance (participation in self-care, productivity, leisure activities) data were gathered from hospital records and using in-person interviews. Interviews occurred at a mean time of 14 (range, 7–24) years post-injury. Hierarchical multiple regression analysis was used to investigate determinants of long-term occupational performance outcomes. Results. Pre-injury behavioural problems, male gender, post-injury cognitive and physical deficits, and lack of access to transportation were significant independent predictors of worse occupational performance outcomes. Conclusions. The study supports the use of a comprehensive model for long-term outcomes after TBI where pre-injury characteristics and post-injury cognitive and physical characteristics account for the greatest proportion of explained variance.
The plasmamitochondrial dna is an independent predictor for posttraumatic systemic inflammatory response syndrome
- Article ID e72834
, 2013
"... Background and Purpose: Mitochondrial DNA (mtDNA), a newly identified damage-associated molecular pattern, has been observed in trauma patients, however, little is known concerning the relationship between plasma mtDNA levels and concrete post-traumatic complications, particularly systemic inflammat ..."
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Background and Purpose: Mitochondrial DNA (mtDNA), a newly identified damage-associated molecular pattern, has been observed in trauma patients, however, little is known concerning the relationship between plasma mtDNA levels and concrete post-traumatic complications, particularly systemic inflammatory response syndrome (SIRS). The aim of this study is to determine whether plasma mtDNA levels are associated with injury severity and cloud predict post-traumatic SIRS in patients with acute traumatic injury. Patients and Methods: Eighty-six consecutive patients with acute traumatic injury were prospectively enrolled in this study. The plasma mtDNA concentration was measured by a real-time, quantitative PCR assay for the human ND2 gene. The study population’s clinical and laboratory data were analyzed. Results: The median plasma mtDNA was higher in trauma patients than in healthy controls (865.196 (251.042-2565.40)pg/ml vs 64.2147 (43.9049-80.6371)pg/ml, P<0.001) and was independently correlated with the ISS score (r=0.287, P<0.001). The plasma mtDNA concentration was also significantly higher in patients who developed post-traumatic SIRS than in patients who did not (1774.03 (564.870-10901.3)pg/ml vs 500.496 (145.415-1285.60)pg/ml, P<0.001). Multiple logistic regression analysis revealed that the plasma mtDNA was an independent predictors for post-traumatic SIRS (OR, 1.183 (95%CI, 1.015-1.379), P=0.032). Further ROC analysis
Inappropriate activation, deactivation, and probable autooxidative damage as a mechanism of neutrophil locomotory defect in trauma
- J. Infect. Dis
, 1986
"... We studied 46 patients who suffered from serious blunt trauma to examine the possible mechanism of their acquired neutrophil (PMN) locomotory dysfunction. Concentrations of plasma C3adeSArg were higher in patients than in controls (310 ± 190 ng/ml vs. 90 ± 28 ng/ml, respectively; P = 3 x 10-5). Both ..."
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We studied 46 patients who suffered from serious blunt trauma to examine the possible mechanism of their acquired neutrophil (PMN) locomotory dysfunction. Concentrations of plasma C3adeSArg were higher in patients than in controls (310 ± 190 ng/ml vs. 90 ± 28 ng/ml, respectively; P = 3 x 10-5). Both resting and phagocytosing PMNs from the patients produced higher quantities of H202 (0.31 ± 0.29 and 5.2 ± 3.4 nmof / lO " PMNs per hr, respectively). These levels resemble the H 20 2 production of normal PMNs preacti-vated with chemotactic factor (0.85 ± 0.03 for normal and 8.2 ± 1.6 nmolz'If) " PMNs per hr for preactivated PMNs). Concentrations of oxidized glutathione were not signifi-cantly higher in PMNs from patients compared with PMNs from controls (0.053 ± 0.057 vs. 0.037 ± 0.046 nmol/In " PMNs, respectively; P =.5). A higher percentage of PMNs from trauma patients than from controls were capped with concanavalin A (66070 ± 11070 vs. 37070 ± 14070, respectively; P = 4 x 10-5) , a result indicating microtubular dysfunc-tion. These findings suggest that in trauma, activation of intravascular complement results in inappropriate chemotactic stimulation and subsequent deactivation and autoxidative damage of circulating PMNs.
