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Kenig A, Nachman D, Aliev E, Wagnert-Avraham L, Kolben Y, Kessler A, Lutsker M, Mevorach D. Apoptotic Cell-Based Therapy for the Modification of the Inflammatory Response to Hemorrhagic Shock. Mil Med 2024; 189:416-422. [PMID: 39160884 DOI: 10.1093/milmed/usae143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/05/2024] [Accepted: 03/15/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Many trauma patients die from hemorrhagic shock in the military and civilian settings. Although two-thirds of hemorrhagic shock victims die of reasons other than exsanguination, such as the consequent cytokine storm, anti-inflammatory therapies failed to be utilized. Apoptotic cell-based treatments enhance innate ability to exert systemic immunomodulation as demonstrated in several clinical applications and hence might present a novel approach in hemorrhagic shock treatment. MATERIALS AND METHODS Twenty-two rats underwent a pressure-controlled hemorrhagic shock model and followed up for 24 hours. An infusion of apoptotic cells (Allocetra-OTS, Enlivex Therapeutics Ltd, Nes Ziona, Israel) was administered to the treatment group. Hemodynamics, blood counts, biochemistry findings, and cytokine profile were compared to a saline-resuscitated control group. RESULTS The treatment group's mean arterial pressure decreased from 94.8 mmHg to 28.2 mmHg, resulting in an 8.13 mg/dL increase in lactate and a 1.9 g/L decrease in hemoglobin, similar to the control group. White blood cells and platelets decreased more profoundly in the treatment group. A similar cytokine profile after 24 hours was markedly attenuated in the treatment group 2 hours after bleeding. Levels of pro-inflammatory cytokines such as interleukin (IL)-1a (28.4 pg/mL vs. 179.1 pg/mL), IL-1b (47.4 pg/mL vs. 103.9 pg/mL), IL-6 (526.2 pg/mL vs. 3492 pg/mL), interferon γ (11.4 pg/mL vs. 427.9 pg/mL), and tumor necrosis factor α (19.0 pg/mL vs. 31.7 pg/mL) were profoundly lower in the treatment group. CONCLUSION In a pressure-control hemorrhagic shock model in rats, apoptotic cell infusion showed preliminary signs of a uniform attenuated cytokine response. Apoptotic cell-based therapies might serve as a novel immunomodulatory therapy for hemorrhagic shock.
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Affiliation(s)
- Ariel Kenig
- The Department of Medicine, Hadassah Medical Center and the Faculty of Medicine, Hebrew University, Jerusalem 911210, Israel
- The Lung Institute, Hadassah Medical Center, Jerusalem 9112102, Israel
| | - Dean Nachman
- The Heart Institute, Hadassah Medical Center and the Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
- Faculty of Medicine, Institute for Research in Military Medicine, The Hebrew University, Jerusalem 9112102, Israel
- Israel Defense Forces, Medical Corps, Ramat Gan 5262000, Israel
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Emil Aliev
- Faculty of Medicine, Institute for Research in Military Medicine, The Hebrew University, Jerusalem 9112102, Israel
- Israel Defense Forces, Medical Corps, Ramat Gan 5262000, Israel
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Linn Wagnert-Avraham
- Faculty of Medicine, Institute for Research in Military Medicine, The Hebrew University, Jerusalem 9112102, Israel
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Yotam Kolben
- The Department of Medicine, Hadassah Medical Center and the Faculty of Medicine, Hebrew University, Jerusalem 911210, Israel
| | - Asa Kessler
- The Department of Medicine, Hadassah Medical Center and the Faculty of Medicine, Hebrew University, Jerusalem 911210, Israel
| | - Maya Lutsker
- Israel Defense Forces, Medical Corps, Ramat Gan 5262000, Israel
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Dror Mevorach
- The Department of Medicine, Hadassah Medical Center and the Faculty of Medicine, Hebrew University, Jerusalem 911210, Israel
- Department of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Hadassah Medical Center and Faculty of Medicine, The Hebrew University, Jerusalem 9112102, Israel
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Yan A, Torpey A, Morrisroe E, Andraous W, Costa A, Bergese S. Clinical Management in Traumatic Brain Injury. Biomedicines 2024; 12:781. [PMID: 38672137 PMCID: PMC11048642 DOI: 10.3390/biomedicines12040781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 04/28/2024] Open
Abstract
Traumatic brain injury is one of the leading causes of morbidity and mortality worldwide and is one of the major public healthcare burdens in the US, with millions of patients suffering from the traumatic brain injury itself (approximately 1.6 million/year) or its repercussions (2-6 million patients with disabilities). The severity of traumatic brain injury can range from mild transient neurological dysfunction or impairment to severe profound disability that leaves patients completely non-functional. Indications for treatment differ based on the injury's severity, but one of the goals of early treatment is to prevent secondary brain injury. Hemodynamic stability, monitoring and treatment of intracranial pressure, maintenance of cerebral perfusion pressure, support of adequate oxygenation and ventilation, administration of hyperosmolar agents and/or sedatives, nutritional support, and seizure prophylaxis are the mainstays of medical treatment for severe traumatic brain injury. Surgical management options include decompressive craniectomy or cerebrospinal fluid drainage via the insertion of an external ventricular drain. Several emerging treatment modalities are being investigated, such as anti-excitotoxic agents, anti-ischemic and cerebral dysregulation agents, S100B protein, erythropoietin, endogenous neuroprotectors, anti-inflammatory agents, and stem cell and neuronal restoration agents, among others.
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Affiliation(s)
- Amy Yan
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (A.Y.); (A.T.); (W.A.); (A.C.)
| | - Andrew Torpey
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (A.Y.); (A.T.); (W.A.); (A.C.)
| | - Erin Morrisroe
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Wesam Andraous
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (A.Y.); (A.T.); (W.A.); (A.C.)
| | - Ana Costa
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (A.Y.); (A.T.); (W.A.); (A.C.)
| | - Sergio Bergese
- Department of Anesthesiology and Neurological Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
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Panda CK, Karim HMR. Deep Machine Learning Might Aid in Combating Intensive Care Unit-Acquired Weakness. Cureus 2024; 16:e58963. [PMID: 38800279 PMCID: PMC11126887 DOI: 10.7759/cureus.58963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Secondary muscle weakness in critically ill patients like intensive care unit (ICU)-associated weakness is frequently noted in patients with prolonged mechanical ventilation and ICU stay. It can be a result of critical illness, myopathy, or neuropathy. Although ICU-acquired weakness (ICU-AW) has been known for a while, there is still no effective treatment for it. Therefore, prevention of ICU-AW becomes the utmost priority, and knowing the risk factors is crucial. Nevertheless, the pathophysiology and the attributing causes are complex for ICU-AW, and proper delineation and formulation of a preventive strategy from such vast, multifaceted data are challenging. Artificial intelligence has recently helped healthcare professionals understand and analyze such intricate data through deep machine learning. Hence, using such a strategy also helps in knowing the risk factors and their weight as contributors, applying them in formulating a preventive path for ICU-AW worth trials.
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Affiliation(s)
- Chinmaya K Panda
- Anaesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Habib Md R Karim
- Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Guwahati, Guwahati, IND
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Barrett CD, Moore HB, Moore EE, Chandler J, Sauaia A. Combination of aspirin and rosuvastatin for reduction of venous thromboembolism in severely injured patients: a double-blind, placebo-controlled, pragmatic randomized phase II clinical trial (The STAT Trial). Blood Coagul Fibrinolysis 2023; 34:499-507. [PMID: 37942744 PMCID: PMC10655842 DOI: 10.1097/mbc.0000000000001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Venous thromboembolism (VTE) remains a significant source of postinjury morbidity and mortality. Beta-hydroxy beta-methylglutaryl-CoA (HMG-CoA) reductase inhibitors (rosuvastatin) significantly reduced pathologic clotting events in healthy populations in a prior trial. Furthermore, acetylsalicylic acid (ASA) has been shown to be noninferior to prophylactic heparinoids for VTE prevention following orthopedic surgery. We hypothesized that a combination of rosuvastatin/ASA, in addition to standard VTE chemoprophylaxis, would reduce VTE in critically ill trauma patients. METHODS This was a double-blind, placebo-controlled, randomized trial, evaluating VTE rates in two groups: ASA + statin (Experimental) and identical placebos (Control). Injured adults, 18-65 years old, admitted to the surgical intensive care unit without contraindications for VTE prophylaxis were eligible. Upon initiation of routine VTE chemoprophylaxis (i.e. heparin/heparin-derivatives), they were randomized to the Experimental or Control group. VTE was the primary outcome. RESULTS Of 112 potentially eligible patients, 33% (n = 37, median new injury severity scale = 27) were successfully randomized, of whom 11% had VTEs. The Experimental group had no VTEs, while the Control group had 6 VTEs (4 PEs and 2 DVTs) in 4 (22%) patients (P = 0.046). The Experimental treatment was not associated with any serious adverse events. Due to the COVID-19 pandemic, the study was interrupted at the second interim analysis at <10% of the planned enrollment, with significance declared at P < 0.012 at that stage. DISCUSSION The combination of ASA and rosuvastatin with standard VTE prophylaxis showed a favorable trend toward reducing VTEs with no serious adverse events. An appropriately powered phase III multicenter trial is needed to further investigate this therapeutic approach. LEVEL OF EVIDENCE Level II, Therapeutic.
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Affiliation(s)
| | | | - Ernest E Moore
- University of Colorado Denver, Department of Surgery
- Shock and Trauma Center at Denver Health, Denver, Colorado
| | | | - Angela Sauaia
- School of Public Health, University of Colorado Denver, Aurora, Colorado, USA
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Efejuku TA, Obanigba G, Johnson D, Obi A, Hallman T, Song J, El Ayadi A, Raji M, Wolf SE. Impact of pre-burn statin use on metabolic and cardiovascular disorders. Am J Surg 2023; 226:485-491. [PMID: 37330384 DOI: 10.1016/j.amjsurg.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/08/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Statins are among the most widely prescribed medications with proven effectiveness in patients with hyperlipidemia and atherosclerotic cardiovascular diseases. We investigated the relationship between statin use, metabolic and cardiovascular outcomes after burn. METHODS We utilized data from the TriNetX electronic health database. Burn patients with prior statin use were compared to patients without prior use and analyzed the occurrence of metabolic and cardiovascular disorders. RESULTS Prior statin use burn patients were 1.33 times as likely to develop hyperglycemia, 1.20 times for cardiac arrhythmia, 1.70 times for coronary artery disease (CAD), 1.10 times for sepsis, and 0.80 times for death. High percent TBSA burn, male sex, and lipophilic statin use were associated with higher odds of outcome development. CONCLUSION Prior statin use in severely burned patients is associated with an increased risk of developing hyperglycemia, arrhythmias, and CAD, with higher odds in males, higher TBSA burn, and lipophilic statin users.
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Affiliation(s)
- Tsola A Efejuku
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Grace Obanigba
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Dominique Johnson
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Ann Obi
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Taylor Hallman
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Juquan Song
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
| | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
| | - Mukaila Raji
- Division of Geriatric & Palliative Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
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Susanto M, Pangihutan Siahaan AM, Wirjomartani BA, Setiawan H, Aryanti C, Michael. The neuroprotective effect of statin in traumatic brain injury: A systematic review. World Neurosurg X 2023; 19:100211. [PMID: 37251243 PMCID: PMC10220252 DOI: 10.1016/j.wnsx.2023.100211] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 04/23/2023] [Accepted: 05/02/2023] [Indexed: 07/22/2023] Open
Abstract
Despite recent encouraging pharmaceutical and technical breakthroughs in neurosurgical critical care, traumatic brain injury (TBI)-related mortality and morbidity remain substantial clinical issues. Medication of statins was revealed to enhance outcomes following TBI in animal research. In addition to their main role of decreasing serum cholesterol, statins decrease inflammation and enhance cerebral blood flow. However, research on the efficacy of statins in TBI is still limited. This systematic review was conducted to determine the efficacy of statins in enhancing the clinical outcomes of TBI individuals, and specifically investigate the optimal dose and form of statins. The databases of PubMed, DOAJ, EBSCO, and Cochrane were extensively researched. The date of publication within the last fifteen years was the inclusion criterion. Meta-analyses, clinical trials, and randomized controlled trials were prioritized forms of research publications. Ambiguous remarks, irrelevant correlations to the main issue, or a focus on disorders other than TBI were the exclusion criteria. Thirteen research were included in this study. Simvastatin, atorvastatin, and rosuvastatin were the main form of statins discussed in this study. Enhancement of the Glasgow Coma Scale, survival rates, hospital length of stay, and cognitive outcomes were revealed in this study. This study suggests either simvastatin 40 mg, atorvastatin 20 mg, or rosuvastatin 20 mg for 10 days as the optimal therapeutic forms and doses to be applied in the management of TBI. Pre-TBI statin use was linked to lower risk of mortality in TBI individuals compared to nonusers, whereas statin discontinuation was linked to an increase in mortality.
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Affiliation(s)
- Martin Susanto
- Faculty of Medicine, University of Sumatera Utara, Medan, North Sumatra, Indonesia
| | | | | | - Hendy Setiawan
- Department of Neurosurgery, University of Sumatera Utara, Medan, North Sumatra, Indonesia
| | - Citra Aryanti
- Department of Surgery, University of Udayana, Denpasar, Bali, Indonesia
| | - Michael
- Department of Neurosurgery, University of Padjadjaran, Bandung, West Java, Indonesia
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Shafiee S, Zali A, Shafizad M, Emami Zeydi A, Ehteshami S, Rezaii F, Tafakhori A, Ertiaei A, Darvishi-Khezri H, Khademloo M, Khoshnood RJ. The Effect of Oral Simvastatin on the Clinical Outcome of Patients with Severe Traumatic Brain Injury: A Randomized Clinical Trial. Ethiop J Health Sci 2021; 31:807-816. [PMID: 34703180 PMCID: PMC8512953 DOI: 10.4314/ejhs.v31i4.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/06/2021] [Indexed: 01/08/2023] Open
Abstract
Background Despite recent promising pharmacological and technological advances in neurosurgical intensive care, the overall TBI-related mortality and morbidity remain high and still pose a major clinical problem. The aim of this study was to evaluate the effect of oral simvastatin on the clinical outcome of patients with severe TBI. Methods In a double-blind placebo-controlled randomized clinical trial a total of 98 patients with severe TBI in Imam Khomeini Hospital in Sari, Iran, were evaluated. Patients who meet the inclusion criteria were randomly allocated into two groups (n=49). In addition to supportive therapies, the intervention group received oral simvastatin (40 mg, daily) for 10 days, and the control group received the placebo (10 days). Patients' Glasgow coma scale (GCS) score, in hospital mortality, duration of mechanical ventilation and length of ICU and neurosurgery ward stay were evaluated during three-time intervals (T1: admission, T2: discharge and T3: one month after discharge). Results The percentage of conscious patients was 18.9% (7 cases) in the simvastatin group and 3.1% (1 case) in controls (P=0.06) at T2. One month after discharge (T3) the proportion of conscious patients significantly increased in the simvastatin group compared to control group (64.9 % versus 28.1 %; P=0.002). There was no significant difference for the mean of GCS score between the simvastatin group and control group at T1 (6.41 ± 1.30 versus 6.41 ± 1.28, respectively; P = 0.98). However, the mean score of GCS in patients who received simvastatin was significantly greater than controls at T2 and T3 (p<0.05). There was no significant differences between two group in-terms of length of mechanical ventilation, ICU and neurosurgery ward stay. Conclusion According to the results of this study it seems that using simvastatin may be an effective and promising therapeutic modality for improving GCS score during TBI recovery.
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Affiliation(s)
- Sajad Shafiee
- Department of Neurosurgery, Orthopedics Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohadaye Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Misagh Shafizad
- Department of Neurosurgery, Orthopedics Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amir Emami Zeydi
- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saeid Ehteshami
- Department of Neurosurgery, Orthopedics Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Rezaii
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Tafakhori
- Iranian Center of Neurological Research (ICNR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolhasan Ertiaei
- Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Hadi Darvishi-Khezri
- Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Khademloo
- Department of Community Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Jalili Khoshnood
- Functional Neurosurgery Research Center, Shohadaye Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Yang M, Hayward RD, Edhayan E. Associations between cardiovascular comorbidities and mortality, length of hospital stay, and total charges among traumatic injury patients. Eur J Trauma Emerg Surg 2019; 47:861-867. [PMID: 31696264 DOI: 10.1007/s00068-019-01253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/22/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Cardiovascular conditions are highly prevalent and particularly common in subsets of the population at high risk for traumatic injury. This study evaluates the extent to which cardiovascular comorbidity may increase risks of negative outcomes in patients receiving trauma treatment. METHODS Clinical data for all patients admitted for traumatic injury (defined by ICD-9 diagnosis codes) of all levels of severity between the years of 2006 and 2014 in the Detroit USA metropolitan area were obtained from the State Inpatient Database for Michigan. The association between four types of cardiovascular comorbidity (hypertension, congestive heart failure, pulmonary circulation disorders, and valvular heart disease), and three outcomes (mortality, length of hospital stay, and total charges), was assessed using generalized linear modeling, both alone and after controlling for injury severity, injury region, and demographic factors. RESULTS All four comorbidities examined were related to worse outcomes on all three dimensions. The greatest magnitude of estimated effects with each outcome was associated with pulmonary circulation disorders (mortality OR = 2.99, length of stay IRR = 1.69, hospital charges IRR = 1.76), and the smallest magnitude of estimated effects was associated with hypertension (mortality OR = 1.20, length of stay IRR = 1.20, hospital charges IRR = 1.18). After adjustment for the presence of multiple comorbidities, injury severity and region, age, gender, and race, all effect estimates remained significant and in the same direction, except valvular heart disease which was unrelated to mortality, and hypertension was related to lower risk of mortality (OR = 0.76). CONCLUSIONS Cardiovascular comorbidities are related to higher risk of negative outcomes among patients hospitalized due to traumatic injury. Screening for these comorbidities on admission may help to improve patient outcomes.
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Affiliation(s)
- Michael Yang
- Department of Surgery, Ascension St. John Hospital, 22151 Moross Rd., PB I, Suite 212, Detroit, MI, 48236, USA
| | - R David Hayward
- Department of Surgery, Ascension St. John Hospital, 22151 Moross Rd., PB I, Suite 212, Detroit, MI, 48236, USA.
| | - Elango Edhayan
- Department of Surgery, Ascension St. John Hospital, 22151 Moross Rd., PB I, Suite 212, Detroit, MI, 48236, USA
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Clay FJ, Hicks AJ, Zaman H, Ponsford J, Batty R, Perry LA, Hopwood M. Prophylaxis Pharmacotherapy to Prevent the Onset of Post-Traumatic Brain Injury Depression: A Systematic Review. J Neurotrauma 2019; 36:2053-2064. [DOI: 10.1089/neu.2018.6244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Fiona J. Clay
- Department of Psychiatry, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Department of Forensic Medicine, Monash University, Southbank, Australia
- Professorial Psychiatry Unit Albert Road Clinic, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Amelia J. Hicks
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Hadar Zaman
- Bradford School of Pharmacy and Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford, United Kingdom
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Rachel Batty
- Department of Psychiatry, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Luke A. Perry
- Department of Psychiatry, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Professorial Psychiatry Unit Albert Road Clinic, Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Eisenstein N, Naumann D, Burns D, Stapley S, Draper H. Left Of Bang Interventions in Trauma: ethical implications for military medical prophylaxis. JOURNAL OF MEDICAL ETHICS 2018; 44:504-508. [PMID: 28814441 DOI: 10.1136/medethics-2017-104299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/12/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
Advances in medical capability should be accompanied by discussion of their ethical implications. In the military medical context there is a growing interest in developing prophylactic interventions that will mitigate the effects of trauma and improve survival. The ethics of this novel capability are currently unexplored. This paper describes the concept of trauma prophylaxis (Left Of Bang Interventions in Trauma) and outlines some of the ethical issues that need to be considered, including within concept development, research and implementation. Trauma prophylaxis can be divided into interventions that do not (type 1) and those that do (type 2) have medical enhancement as an unintended side effect of their prophylactic action. We conclude that type 1 interventions have much in common with established military medical prophylaxis, and the potentially enhancing qualities of type 2 interventions raise different issues. We welcome further debate on both interventions.
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Affiliation(s)
- Neil Eisenstein
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham, UK
- Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Edgbaston, UK
| | - David Naumann
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham, UK
- Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Edgbaston, UK
| | - Daniel Burns
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham, UK
- Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Edgbaston, UK
| | - Sarah Stapley
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham, UK
| | - Heather Draper
- Division of Health Science, Warwick Medical School, University of Warwick, Coventry, UK
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Shahrezaee M, Oryan A, Bastami F, Hosseinpour S, Shahrezaee MH, Kamali A. Comparative impact of systemic delivery of atorvastatin, simvastatin, and lovastatin on bone mineral density of the ovariectomized rats. Endocrine 2018; 60:138-150. [PMID: 29372484 DOI: 10.1007/s12020-018-1531-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/12/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE In addition to lipid-lowering properties, statins have been suggested to affect bone turnover by increasing the osteoblastic bone formation and blocking the osteoclastogenesis. However, there are many controversial reports regarding the beneficial effect of statins on osteoporosis. In this study, we investigated the therapeutic effects of the most important lipophilic statins administered orally for 60 days to the ovariectomized (OVX) female Sprague-Dawley rats and compared the effects on different harvested trabecular and compact bones. METHODS Thirty female rats were divided into five equal groups including the normal rats, untreated OVX rats (negative control), and the OVX rats treated with atorvastatin (20 mg/kg/day), simvastatin (25 mg/kg/day), and lovastatin (20 mg/kg/day). The osteoporotic animals were treated daily for 60 days and euthanized at the end of experiments. The effectiveness of these treatments was evaluated by biomechanical testing, histopathologic, histomorphometric, micro-CT scan, real-time PCR, and serum biochemical analysis. Moreover, the hepatotoxicity and rhabdomyolysis related with these treatments were assessed by biochemistry analysis and histopathological evaluation. RESULTS The results and statistical analysis showed that systemic delivery of simvastatin and lovastatin significantly increased serum calcium level, expression of osteogenic genes, bone mineral density (BMD), and biomechanical properties in comparison to the untreated OVX rats, especially in trabecular bones (P < 0.05). The results of different analysis also indicated that there was no statistical difference between the atorvastatin-treated animals and the negative control. Among all treatments, only atorvastatin showed an evident hepatotoxicity and myopathy. CONCLUSIONS It was concluded that the lovastatin and simvastatin efficiently ameliorated the OVX-induced osteoporosis. Moreover, the simvastatin-treated animals showed more resemblance to the normal group in terms of BMD, expression of osteogenic genes, serum biochemical parameters, histomorphometric findings, and biomechanical performance with no significant side-effects.
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Affiliation(s)
- Mostafa Shahrezaee
- Department of Orthopedic Surgery, School of Medicine, AJA University of Medical Science, Tehran, Iran
| | - Ahmad Oryan
- Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Farshid Bastami
- Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepanta Hosseinpour
- Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amir Kamali
- Department of Orthopedic Surgery, School of Medicine, AJA University of Medical Science, Tehran, Iran.
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12
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McMahon RA, Fletcher JL, Aden JK, Holland SR, Trexler ST, Blackbourne LH. Preinjury statin use and thromboembolic events in trauma: a 10-year retrospective evaluation. J Surg Res 2018; 226:100-111. [PMID: 29661275 DOI: 10.1016/j.jss.2017.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/13/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Traumatic injury is well known to increase the risk of venous thromboembolic events (VTEs), occurring in up to 58% of trauma patients. Statin medications have significant anti-inflammatory properties and have been shown to reduce the risk of VTE. We hypothesized that trauma patients who received statin medication before injury would have a lower incidence of VTE after injury. METHODS A 10-y retrospective review identified all patients admitted to our trauma service with an injury severity score >9 and an intensive care unit stay of >3 d. This population was categorized as either "statin recipient" (SR) or "statin naïve," with subsequent categorical division by occurrence of VTE. Our primary outcome measure was the occurrence of documented VTE in both statin naïve and SR subjects. RESULTS A total of 2519 trauma patients were included with 97 (3.8%) developing VTE. Pretrauma statin use in males remained as an independent predictor of VTE (odds ratio = 2.25, 95% confidence interval = 1.25-4.04, P < 0.01). The median time to VTE onset was 3 d longer in SRs (10.0 d; confidence interval = 7.3-12.7, P < 0.05). CONCLUSIONS Pretrauma statin use does not appear to have a protective benefit of VTE prevention in trauma patients, as we have shown pretrauma SR male trauma patients to have a twofold increased incidence of VTE. However, when considering the 3 d longer median time to VTE onset found in SRs, we consider the protective benefit of statin use reported in the current literature as likely attributable to this observed delayed onset.
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Affiliation(s)
- Ryan A McMahon
- Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas.
| | - John L Fletcher
- Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - James K Aden
- Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Seth R Holland
- Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Scott T Trexler
- Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Lorne H Blackbourne
- Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas
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13
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Ghalem A, Boussir H, Ahsayan K, Ismaili N, Ouafi NE. ST-segment elevation after blunt chest trauma: myocardial contusion with normal coronary arteries or myocardial infarction following coronary lesions. Pan Afr Med J 2017; 28:26. [PMID: 29138662 PMCID: PMC5681017 DOI: 10.11604/pamj.2017.28.26.12272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/11/2017] [Indexed: 12/22/2022] Open
Abstract
Cardiac lesions secondary to blunt chest trauma vary from insignificant arrhythmias to fatal cardiac rupture. Of these, a distinction remains difficult; face to ST-segment elevation on ECG with positive cardiac biomarkers, is it a myocardial contusion or a genuine myocardial infarction (MI) secondary to coronary lesions? We report the case of a patient admitted for multiple trauma. Initial assessment showed an ST segment elevation on ECG, along with multiple fractures and abdominal injuries. We would like to discuss, through this case, the similarities and the differences between myocardial infarction due to coronary lesions and myocardial contusion in a traumatic context, but also emphasize the difficulty of striking the right balance between thrombotic and bleeding risks in this situation, and insist on the importance of a multidisciplinary and collegial reflexion so we can offer these patients the best care there is.
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Affiliation(s)
- Amine Ghalem
- Department of Cardiology, Mohammed VI University Hospital, 60049 Oujda, Morocco
| | - Hanane Boussir
- Department of Cardiology, Mohammed VI University Hospital, 60049 Oujda, Morocco
| | - Kamal Ahsayan
- Department of Anesthesia and Intensive Care, Mohammed VI University Hospital, 60049 Oujda, Morocco
| | - Nabila Ismaili
- Department of Cardiology, Mohammed VI University Hospital, 60049 Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital, 60049 Oujda, Morocco
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14
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Khokhar B, Simoni-Wastila L, Slejko JF, Perfetto E, Zhan M, Smith GS. Patterns of Statin Use in Older Medicare Beneficiaries With Traumatic Brain Injury. J Pharm Technol 2017; 33:156-166. [PMID: 29577114 PMCID: PMC5863738 DOI: 10.1177/8755122517710671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In addition to lowering lipids, statins also may be beneficial for older adults sustaining a traumatic brain injury (TBI), as statin use prior to and following trauma may decrease mortality following injury. However, despite statins' potential to reduce mortality, there is limited research regarding statin use among older adults. OBJECTIVE To characterize and investigate factors associated with statin use among older adults with TBI. METHODS A retrospective drug utilization study was used to characterize statin use among Medicare beneficiaries 65 and older hospitalized with a TBI during 2006 to 2010 and with continuous Medicare Parts A, B, and D coverage 6 months prior and 12 months following TBI. Logistic regression was used to investigate the factors associated with statin use. The exposure of interest was statin use prior to and following TBI. RESULTS Of the 75 698 beneficiaries included in the study, 37 874 (~50%) of beneficiaries used a statin at least once during the study period. The most common statin used was simvastatin, while fluvastatin was the least used statin. Statin users were more likely to have cardiovascular diseases when compared to nonusers. Hyperlipidemia was a major factor associated with statin use and had the greatest impact on statin use compared to nonuse (odds ratio = 9.54; 95% confidence interval = 9.07, 10.03). CONCLUSIONS This national sample of older adults with TBI suggests that statins are commonly used. Future studies must next examine the impact of statin use on mortality and secondary injury in order to shape pharmacological therapy guidelines following TBI.
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Affiliation(s)
| | | | | | - Eleanor Perfetto
- University of Maryland, Baltimore, MD,
USA
- National Health Council, Washington, DC,
USA
| | - Min Zhan
- University of Maryland, Baltimore, MD,
USA
| | - Gordon S. Smith
- University of Maryland, Baltimore, MD,
USA
- West Virginia University, Morgantown,
WV, USA
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15
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Naghibi T, Madani S, Mazloomzadeh S, Dobakhti F. Simvastatin's effects on survival and outcome in traumatic braininjury patients: a comparative study. Turk J Med Sci 2016; 46:1-5. [PMID: 27511325 DOI: 10.3906/sag-1404-125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 10/17/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Mortality and morbidity still remain high in patients with traumatic brain injuries. Understanding the role of new treatments in these patients is critical. The aim of this study was to determine the effect of simvastatin on survival and outcome in traumatic brain injury patients. MATERIALS AND METHODS Forty-four patients were assigned to receive either simvastatin or a placebo. The serum interleukin-6 and C-reactive protein levels were measured at the first 24 h and 48 h after trauma. All data, including the Glasgow Coma Scale score, survival at discharge, length of intensive care unit stay, and duration of mechanical ventilation, were collected. The effect of simvastatin on the collected data was then investigated. RESULTS The Glasgow Coma Scale level at discharge was significantly higher in the simvastatin group. The overall mortality rate, duration of mechanical ventilation, and length of intensive care unit stay were similar between the 2 groups. The C-reactive protein concentration 48 h after trauma was significantly lower in the simvastatin group, but there was no significant difference according to the interleukin-6 level 48 h after trauma between the 2 groups. CONCLUSION Simvastatin could be suggested as an adjunctive therapy in traumatic brain injury patients.
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Affiliation(s)
- Taraneh Naghibi
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Zanjan University of Medical Science, Zanjan, Iran
| | - Sara Madani
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Zanjan University of Medical Science, Zanjan, Iran
| | - Saideh Mazloomzadeh
- Department of Epidemiology, School of Medicine, Zanjan University of Medical Science, Zanjan, Iran
| | - Faramarz Dobakhti
- School of Pharmacy, Zanjan University of Medical Science, Zanjan, Iran
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16
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Tan J, Yang N, Fu X, Cui Y, Guo Q, Ma T, Yin X, Leng H, Song C. Single-dose local simvastatin injection improves implant fixation via increased angiogenesis and bone formation in an ovariectomized rat model. Med Sci Monit 2015; 21:1428-39. [PMID: 25982481 PMCID: PMC4448596 DOI: 10.12659/msm.892247] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Statins have been reported to promote bone formation. However, taken orally, their bioavailability is low to the bones. Implant therapies require a local repair response, topical application of osteoinductive agents, or biomaterials that promote implant fixation. Material/Methods The present study evaluated the effect of a single local injection of simvastatin on screw fixation in an ovariectomized rat model of osteoporosis. Results Dual-energy X-ray absorptiometry, micro-computed tomography, histology, and biomechanical tests revealed that 5 and 10 mg simvastatin significantly improved bone mineral density by 18.2% and 22.4%, respectively (P<0.05); increased bone volume fraction by 51.0% and 57.9%, trabecular thickness by 16.4% and 18.9%, trabeculae number by 112.0% and 107.1%, and percentage of osseointegration by 115.7% and 126.3%; and decreased trabeculae separation by 34.1% and 36.6%, respectively (all P<0.01). Bone mineral apposition rate was significantly increased (P<0.01). Furthermore, implant fixation was significantly increased (P<0.05), and bone morphogenetic protein 2 (BMP2) expression was markedly increased. Local injection of a single dose of simvastatin also promoted angiogenesis. Vessel number, volume, thickness, surface area, and vascular volume per tissue volume were significantly increased (all P<0.01). Vascular endothelial growth factor (VEGF), VEGF receptor-2, von Willebrand factor, and platelet endothelial cell adhesion molecule-1 expression were enhanced. Conclusions A single local injection of simvastatin significantly increased bone formation, promoted osseointegration, and enhanced implant fixation in ovariectomized rats. The underlying mechanism appears to involve enhanced BMP2 expression and angiogenesis in the target bone.
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Affiliation(s)
- Jie Tan
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
| | - Ning Yang
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
| | - Xin Fu
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
| | - Yueyi Cui
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
| | - Qi Guo
- Department of Neurology, Peking University Third Hospital, Beijing, China (mainland)
| | - Teng Ma
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
| | - Xiaoxue Yin
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
| | - Huijie Leng
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
| | - Chunli Song
- Department of Orthopaedic, Peking University Third Hospital, Beijing, China (mainland)
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17
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Abstract
PURPOSE OF REVIEW This review article explores the recent literature regarding the optimal type and amount of intravenous fluids for the trauma patient from the time of injury through their ICU stay. It discusses damage control principles as well as targeted resuscitation utilizing new technology. RECENT FINDINGS In the prehospital arena, intravenous fluids have been associated with worse patient outcomes due to increased coagulopathy and time to definitive care. Once in the trauma bay, damage control resuscitation principles apply to the severely injured patient. Large volume crystalloid infusion increases mortality. The best patient outcomes have been found with transfusion of blood products in a ratio that closely mimics whole blood. Thrombelastography is a useful adjunct in resuscitation and can help guide the judicious use of blood products. New technology can help providers ascertain when a patient is appropriately resuscitated by determining adequate global and regional perfusion. SUMMARY During the resuscitation of the acutely injured patient, crystalloids should be limited in favor of blood components. Damage control principles apply until definitive hemostasis is obtained, at which point the focus should change to targeted resuscitation using traditional global endpoints of resuscitation in conjunction with determinants of regional perfusion.
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18
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Kochanek PM, Jackson TC, Ferguson NM, Carlson SW, Simon DW, Brockman EC, Ji J, Bayir H, Poloyac SM, Wagner AK, Kline AE, Empey PE, Clark RS, Jackson EK, Dixon CE. Emerging therapies in traumatic brain injury. Semin Neurol 2015; 35:83-100. [PMID: 25714870 PMCID: PMC4356170 DOI: 10.1055/s-0035-1544237] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Despite decades of basic and clinical research, treatments to improve outcomes after traumatic brain injury (TBI) are limited. However, based on the recent recognition of the prevalence of mild TBI, and its potential link to neurodegenerative disease, many new and exciting secondary injury mechanisms have been identified and several new therapies are being evaluated targeting both classic and novel paradigms. This includes a robust increase in both preclinical and clinical investigations. Using a mechanism-based approach the authors define the targets and emerging therapies for TBI. They address putative new therapies for TBI across both the spectrum of injury severity and the continuum of care, from the field to rehabilitation. They discussTBI therapy using 11 categories, namely, (1) excitotoxicity and neuronal death, (2) brain edema, (3) mitochondria and oxidative stress, (4) axonal injury, (5) inflammation, (6) ischemia and cerebral blood flow dysregulation, (7) cognitive enhancement, (8) augmentation of endogenous neuroprotection, (9) cellular therapies, (10) combination therapy, and (11) TBI resuscitation. The current golden age of TBI research represents a special opportunity for the development of breakthroughs in the field.
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Affiliation(s)
- Patrick M. Kochanek
- Safar Center for Resuscitation Research, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania
- Departments of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Travis C. Jackson
- Safar Center for Resuscitation Research, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania
- Departments of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nikki Miller Ferguson
- Safar Center for Resuscitation Research, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania
- Departments of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shaun W. Carlson
- Safar Center for Resuscitation Research, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania
- Departmentol Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dennis W. Simon
- Safar Center for Resuscitation Research, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania
- Departments of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Erik C. Brockman
- Safar Center for Resuscitation Research, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania
- Departments of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jing Ji
- Safar Center for Resuscitation Research, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania
- Departments of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hülya Bayir
- Safar Center for Resuscitation Research, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania
- Departments of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Environmental and Occupational Health, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Samuel M. Poloyac
- Safar Center for Resuscitation Research, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Environmental and Occupational Health, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Amy K. Wagner
- Safar Center for Resuscitation Research, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Anthony E. Kline
- Safar Center for Resuscitation Research, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Philip E. Empey
- Safar Center for Resuscitation Research, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Environmental and Occupational Health, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert S.B. Clark
- Safar Center for Resuscitation Research, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania
- Departments of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Edwin K. Jackson
- Safar Center for Resuscitation Research, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - C. Edward Dixon
- Safar Center for Resuscitation Research, University of Pittburgh School of Medicine, Pittsburgh, Pennsylvania
- Departmentol Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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19
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Lee KC, Joory K, Moiemen NS. History of burns: The past, present and the future. BURNS & TRAUMA 2014; 2:169-80. [PMID: 27574647 PMCID: PMC4978094 DOI: 10.4103/2321-3868.143620] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/25/2014] [Accepted: 09/27/2014] [Indexed: 12/20/2022]
Abstract
Burn injuries are one of the most common and devastating afflictions on the human body. In this article we look back at how the treatment of burns has evolved over the centuries from a primarily topical therapy consisting of weird and wonderful topical concoctions in ancient times to one that spans multiple scientific fields of topical therapy, antibiotics, fluid resuscitation, skin excision and grafting, respiratory and metabolic care and nutrition. Most major advances in burn care occurred in the last 50 years, spurred on by wars and great fires. The use of systemic antibiotics and topical silver therapy greatly reduced sepsis related mortality. This along with the advent of antiseptic surgical techniques, burn depth classification and skin grafting allowed the excision and coverage of full-thickness burns which resulted in greatly improved survival rates. Advancements in the methods of assessing the surface area of burns paved way for more accurate fluid resuscitation, minimising the effects of shock and avoiding fluid over-loading. The introduction of metabolic care, nutritional support and care of inhalational injuries further improved the outcome of burn patients. We also briefly discuss some future directions in burn care such as the use of cell and pharmalogical therapies.
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Affiliation(s)
- Kwang Chear Lee
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, UK
| | - Kavita Joory
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, UK
| | - Naiem S. Moiemen
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, UK
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20
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Lord JM, Midwinter MJ, Chen YF, Belli A, Brohi K, Kovacs EJ, Koenderman L, Kubes P, Lilford RJ. The systemic immune response to trauma: an overview of pathophysiology and treatment. Lancet 2014; 384:1455-65. [PMID: 25390327 PMCID: PMC4729362 DOI: 10.1016/s0140-6736(14)60687-5] [Citation(s) in RCA: 481] [Impact Index Per Article: 48.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Improvements in the control of haemorrhage after trauma have resulted in the survival of many people who would otherwise have died from the initial loss of blood. However, the danger is not over once bleeding has been arrested and blood pressure restored. Two-thirds of patients who die following major trauma now do so as a result of causes other than exsanguination. Trauma evokes a systemic reaction that includes an acute, non-specific, immune response associated, paradoxically, with reduced resistance to infection. The result is damage to multiple organs caused by the initial cascade of inflammation aggravated by subsequent sepsis to which the body has become susceptible. This Series examines the biological mechanisms and clinical implications of the cascade of events caused by large-scale trauma that leads to multiorgan failure and death, despite the stemming of blood loss. Furthermore, the stark and robust epidemiological finding--namely, that age has a profound influence on the chances of surviving trauma irrespective of the nature and severity of the injury--will be explored. Advances in our understanding of the inflammatory response to trauma, the impact of ageing on this response, and how this information has led to new and emerging treatments aimed at combating immune dysregulation and reduced immunity after injury will also be discussed.
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Affiliation(s)
- Janet M Lord
- MRC-ARUK Centre for Musculoskeletal Ageing Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK; NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Mark J Midwinter
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK; School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Yen-Fu Chen
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK; School of Health and Population Sciences, University of Birmingham, Birmingham, UK; Division of Health Sciences, University of Warwick, Coventry, UK
| | - Antonio Belli
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK; Neurotrauma and Neurodegeneration Section, University of Birmingham, Birmingham, UK
| | - Karim Brohi
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Elizabeth J Kovacs
- Loyola University Chicago Health Sciences Campus, Stritch School of Medicine, Department of Surgery, Burn and Shock Trauma Institute, Maywood, IL, USA
| | - Leo Koenderman
- University Medical Centre Utrecht, Department of Respiratory Medicine, Utrecht, Netherlands
| | - Paul Kubes
- University of Calgary, Department of Physiology and Pharmacology, Calvin Phoebe and Joan Snyder Institute for Chronic Disease, Calgary, Canada
| | - Richard J Lilford
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK; Division of Health Sciences, University of Warwick, Coventry, UK.
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21
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Holmes M, Garver M, Albrecht L, Arbabi S, Pham TN. Comparison of two comorbidity scoring systems for older adults with traumatic injuries. J Am Coll Surg 2014; 219:631-7. [PMID: 25154672 DOI: 10.1016/j.jamcollsurg.2014.05.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/23/2014] [Accepted: 05/23/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND The purpose of this study was to determine the mortality predictive value of two different comorbidity scores, Comorbidity-Polypharmacy Score (CPS) and Charlson scoring system, in a large sample of older trauma patients. STUDY DESIGN At an urban tertiary care Level I trauma center, trauma patients aged 55 years and older who were initially admitted to critical care were included. This retrospective chart review was conducted at Harborview Medical Center in Seattle, WA. Older trauma patients admitted from January 1, 2010 through December 31, 2010 were screened for inclusion. One-year mortality data were obtained from the Washington State Department of Health. Covariates included age, presence of hypotension, traumatic brain injury, and Injury Severity Score. RESULTS Records for 667 older trauma patients were reviewed. In multivariate analyses, CPS was an independent predictor of fatal outcomes. Higher CPS was associated with greater mortality, however, it was not superior to Charlson methodology in predicting 1-year mortality in this patient cohort. CONCLUSIONS The addition of a comorbidity score improves multivariate models predicting long-term mortality in older trauma patients. There was no advantage to using CPS instead of Charlson score, and each was an independent predictor of fatal outcomes.
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Affiliation(s)
- Meredith Holmes
- Department of Pharmacy, University of Washington, Harborview Medical Center, Seattle, WA.
| | - Matt Garver
- Department of Pharmacy, University of Washington, Harborview Medical Center, Seattle, WA
| | | | - Saman Arbabi
- Department of Surgery, Division of Trauma, Burns and Critical Care, University of Washington, Harborview Medical Center, Seattle, WA
| | - Tam N Pham
- Department of Surgery, Division of Trauma, Burns and Critical Care, University of Washington, Harborview Medical Center, Seattle, WA
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