1
|
Bonfim DS, Fernandes ML, Muniz IPR, Pereira ÍS, da Silva RAA, Cristina da Silva F, Santos GPDO, Pereira Rosa L. Effectiveness of 780 nm photobiomodulation as adjunct treatment for bone exposed fractures: A pilot study on radiograph, pain, and cytokines analysis. JOURNAL OF BIOPHOTONICS 2024; 17:e202300348. [PMID: 38339853 DOI: 10.1002/jbio.202300348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/25/2023] [Accepted: 12/27/2023] [Indexed: 02/12/2024]
Abstract
The aim of this study was to evaluate the effectiveness of photobiomodulation with a 780 nm laser as an adjunct to surgical treatment in the regeneration of bone fractures. Twenty patients diagnosed with open fractures in the lower limbs were selected and randomly divided into two groups: control and LLLT. LLLT parameter: 780 nm, 0.04 cm2 of light beam diameter, 40 mW of power, 10 s per point, 0.4 J of energy, fluence of 10 J/cm2 and irradiance of 1 W/cm2. The evaluated data were: pain, using McGill scale, use of analgesics and anti-inflammatories, levels of cytokines TNF-α, IFN-γ, IL-1β, IL-10, and IL-17, and bone level regeneration. Data were analyzed using Wilcoxon and Mann-Whitney tests (5%). We can conclude that LLLT was effective as an adjuvant in the bone fracture regeneration process, altered IL-1β levels, reduced the use of analgesics and anti-inflammatories, reducing the pain pattern throughout the sessions.
Collapse
|
2
|
Kasraian L, Naderi N, Hosseini M, Taheri Akerdi A, Paydar S, Abdolrahimzadeh Fard H. A novel scoring system for early prediction of massive transfusion requirement in trauma patients. Intern Emerg Med 2024:10.1007/s11739-024-03541-7. [PMID: 38583098 DOI: 10.1007/s11739-024-03541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 01/16/2024] [Indexed: 04/08/2024]
Abstract
Early resuscitation using blood products is critical for patients with severe hemorrhagic shock. We aimed to develop and validate a new scoring system, hemorrhagic shock transfusion prediction (HSTP) score, to predict the need for massive transfusion (MT) in these patients, compared to the widely used Assessment of Blood Consumption (ABC) score. Trauma patients admitted to Emtiaz Hospital in Iran from 2017 to 2021 were retrospectively included. Patients assigned a code 1 or 2 according to the Emergency severity index (ESI) triage system have been divided into MT and non-MT groups. MT was defined as receiving ≥ 10 units of packed cells (PCs) in 24 h. Demographic information, admission vital signs, and lab results available within 15 min were compared between the groups. A new predictive score was developed using logistic regression of statistically significant parameters. Out of 1029 patients, 651 (63.3%) required MT. An arrival, diastolic blood pressure < 79.5 mm Hg, absolute lymphocyte count > 1850/μL, base excess < - 4.25, and blood glucose > 156 mg/dL were independent predictors included in the HSTP score. The sensitivity and specificity were 74.36% and 53.87% for the HSTP score, compared to 31.03% and 76.16% for the ABC score. Moreover, the positive and negative predictive values were 77.88% and 49.03% for the HSTP score, versus 74.15% and 33.66% for ABC. The new scoring system demonstrated higher sensitivity and improved positive and negative predictive values compared to the ABC score. This score can assist physicians in making accurate transfusion decisions quickly, but further prospective studies are warranted to validate its clinical utility.
Collapse
Affiliation(s)
- Leila Kasraian
- Blood Transfusion Research Centre, Higher Institute for Research and Education in Transfusion Medicine, Shiraz, Iran
| | - Nima Naderi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Hosseini
- Truama Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Taheri Akerdi
- Truama Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Paydar
- Truama Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Abdolrahimzadeh Fard
- Truama Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
3
|
Ting RS, King KL, Lewis DP, Weaver NA, Balogh ZJ. Modifiability of surgical timing in postinjury multiple organ failure patients. World J Surg 2024; 48:350-360. [PMID: 38686758 DOI: 10.1002/wjs.12076] [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: 11/04/2023] [Accepted: 12/27/2023] [Indexed: 05/02/2024]
Abstract
BACKGROUND Postinjury multiple organ failure (MOF) is the leading cause of late trauma deaths, with primarily non-modifiable risk factors. Timing of surgery as a potentially modifiable risk factor is frequently proposed, but has not been quantified. We aimed to compare mortality, hospital length of stay (LOS), and ICU LOS between MOF patients who had surgery that preceded MOF with modifiable timings versus those with non-modifiable timings. METHODS Retrospective analysis of an ongoing 17-year prospective cohort study of ICU polytrauma patients at-risk of MOF. Among MOF patients (Denver score>3), we identified patients who had surgery that preceded MOF, determined whether the timing of these operation(s) were modifiable(M) or non-modifiable (non-M), and evaluated the change in physiological parameters as a result of surgery. RESULTS Of 716 polytrauma patients at-risk of MOF, 205/716 (29%) developed MOF, and 161/205 (79%) had surgery during their ICU admission. Of the surgical MOF patients, 147/161 (91%) had one or more operation(s) that preceded MOF, and 65/161 (40%) of them had operation(s) with modifiable timings. There were no differences in age (mean (SD) 52 (19) vs 53 (21)years), injury severity score (median (IQR) 34 (26-41)vs34 (25-44)), admission physiological and resuscitation parameters, between M and non-M-patients. M patients had longer ICU LOS (median (IQR) 18 (12-28)versus 11 (8-16)days, p < 0.0001) than non-M-patients, without difference in mortality (14%vs16%, p = 0.7347), or hospital LOS (median (IQR) 32 (18-52)vs27 (17-47)days, p = 0.3418). M-patients had less fluids and transfusions intraoperatively. Surgery did not compromise patient physiology. CONCLUSION Operations preceding MOF are common in polytrauma and seem to be safe in maintaining physiology. The margin for improvement from optimizing surgical timing is modest, contrary to historical assumptions.
Collapse
Affiliation(s)
- Ryan S Ting
- St George & Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate L King
- John Hunter Hospital and University of Newcastle, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Daniel P Lewis
- John Hunter Hospital and University of Newcastle, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Natasha A Weaver
- University of Newcastle, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Zsolt J Balogh
- John Hunter Hospital and University of Newcastle, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| |
Collapse
|
4
|
Hong Z, Cui B, Sheng Y, Lu Y, Bai X, Wu X, Cheng T, Jin D, Gou Y. Effects of da Vinci robot versus thoracoscopic surgery on body trauma and lymphocyte subsets in lung cancer patients: A propensity score matching study. J Surg Oncol 2023; 128:667-674. [PMID: 37171070 DOI: 10.1002/jso.27312] [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] [Received: 01/07/2023] [Revised: 04/22/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND To assess the impact of da Vinci robot versus thoracoscopic surgery on body trauma and lymphocyte subsets in lung cancer patients. METHODS Retrospective analysis of 352 patients with lung cancer treated by minimally invasive surgery completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from October 2019 to October 2022. According to the surgical procedure, the patients were divided into a robotic-assisted thoracic surgery (RATS) group (n = 159) and a video-assisted thoracoscopic surgery group (VATS) (n = 193), respectively. Propensity score matching (PSM) analysis was performed in both groups, and perioperative indicators were recorded. Levels of inflammatory markers (C-reactive protein, CRP; interleukin-6, IL-6) and lymphocyte subsets (CD3+ , CD4+ , CD8+ , and CD4+ /CD8+ ) were measured 1 day before surgery and 1, 3, and 5 days after surgery, respectively. To compare the effects of the two surgical procedures on the trauma and lymphocyte subsets of the patient's organism. RESULTS One hundred and thirty-eight patients in each group after PSM. Compared with the VATS group, the RATS group had shorter operative time (p < 0.001), less intraoperative bleeding (p < 0.001), less postoperative chest drainage (p = 0.029), shorter postoperative chest drainage time (p = 0.008), and shorter postoperative hospital stay (p = 0.005). The levels of CRP and IL-6 increased in both groups after surgery compared with those before surgery, and the increase was less in the RATS group than that in the VATS group. Postoperative T-lymphocyte levels were lower in both groups compared with preoperative levels, and T-lymphocyte levels were significantly lower in the VATS group compared with the RATS group. CONCLUSION Compared with VATS for treating lung cancer, RATS has advantages in short-term efficacy, and smaller surgical trauma to patients, which can reduce the body's inflammatory response. It also has less impact on T lymphocyte subpopulations, which can better protect patients' immune function.
Collapse
Affiliation(s)
- Ziqiang Hong
- Gansu Provincial Hospital, The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Baiqiang Cui
- Gansu Provincial Hospital, The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Yannan Sheng
- Gansu Provincial Hospital, The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
| | - Yingjie Lu
- Gansu Provincial Hospital, The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
| | - Xiangdou Bai
- Gansu Provincial Hospital, The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Xusheng Wu
- Gansu Provincial Hospital, The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Tao Cheng
- Gansu Provincial Hospital, The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Dacheng Jin
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Yunjiu Gou
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| |
Collapse
|
5
|
Aggas JR, Abasi S, Ton C, Salehi S, Liu R, Brandacher G, Grayson WL, Guiseppi-Elie A. Real-Time Monitoring Using Multiplexed Multi-Electrode Bioelectrical Impedance Spectroscopy for the Stratification of Vascularized Composite Allografts: A Perspective on Predictive Analytics. Bioengineering (Basel) 2023; 10:bioengineering10040434. [PMID: 37106621 PMCID: PMC10135882 DOI: 10.3390/bioengineering10040434] [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] [Received: 02/06/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 04/29/2023] Open
Abstract
Vascularized composite allotransplantation addresses injuries to complex anatomical structures such as the face, hand, and abdominal wall. Prolonged static cold storage of vascularized composite allografts (VCA) incurs damage and imposes transportation limits to their viability and availability. Tissue ischemia, the major clinical indication, is strongly correlated with negative transplantation outcomes. Machine perfusion and normothermia can extend preservation times. This perspective introduces multiplexed multi-electrode bioimpedance spectroscopy (MMBIS), an established bioanalytical method to quantify the interaction of the electrical current with tissue components, capable of measuring tissue edema, as a quantitative, noninvasive, real-time, continuous monitoring technique to provide crucially needed assessment of graft preservation efficacy and viability. MMBIS must be developed, and appropriate models explored to address the highly complex multi-tissue structures and time-temperature changes of VCA. Combined with artificial intelligence (AI), MMBIS can serve to stratify allografts for improvement in transplantation outcomes.
Collapse
Affiliation(s)
- John R Aggas
- Bioelectronics, Biosensors and Biochips (C3B®), Department of Biomedical Engineering, Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77843, USA
- Test Development, Roche Diagnostics, 9115 Hague Road, Indianapolis, IN 46256, USA
| | - Sara Abasi
- Bioelectronics, Biosensors and Biochips (C3B®), Department of Biomedical Engineering, Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77843, USA
- Media and Metabolism, Wildtype, Inc., 2325 3rd St., San Francisco, CA 94107, USA
| | - Carolyn Ton
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Sara Salehi
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Renee Liu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Gerald Brandacher
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Warren L Grayson
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Anthony Guiseppi-Elie
- Bioelectronics, Biosensors and Biochips (C3B®), Department of Biomedical Engineering, Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77843, USA
- Department of Cardiovascular Sciences, Houston Methodist Institute for Academic Medicine and Houston Methodist Research Institute, 6670 Bertner Ave., Houston, TX 77030, USA
- ABTECH Scientific, Inc., Biotechnology Research Park, 800 East Leigh Street, Richmond, VA 23219, USA
| |
Collapse
|
6
|
Noshadi N, Heidari M, Naemi Kermanshahi M, Zarezadeh M, Sanaie S, Ebrahimi-Mameghani M. Effects of Probiotics Supplementation on CRP, IL-6, and Length of ICU Stay in Traumatic Brain Injuries and Multiple Trauma Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:4674000. [PMID: 36518854 PMCID: PMC9744609 DOI: 10.1155/2022/4674000] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/05/2022] [Accepted: 11/12/2022] [Indexed: 12/01/2023]
Abstract
METHOD This meta-analysis aims to evaluate the effectiveness of probiotics in reducing inflammatory biomarkers and the length of intensive care unit (ICU) stays. PubMed-Medline, SCOPUS, Embase, and Google Scholar databases up to July 2021 were searched. The meta-analysis was carried out using random-effect analysis. To determine the sources of heterogeneity, subgroup analyses were performed. In case of the presence of publication bias, trim and fill analysis was carried out. The Cochrane Collaboration tool was used for checking the quality assessment. We hypothesized that probiotics would improve inflammatory markers (CRP and IL-6) and the length of ICU stay in traumatic brain injury and multiple trauma patients. RESULTS The present meta-analysis, which includes a total of seven studies, showed that there were no significant effects of probiotics supplementation on interleukin (IL)-6 (Hedges's g = -2.46 pg/ml; 95% CI: -12.16, 7.25; P=0.39), C-reactive protein (CRP) (Hedges's g = -1.10 mg/L; 95% CI: -2.27, 0.06; P=0.06), and the length of staying in ICU. The overall number of RCTs included in the analysis and the total sample size were insufficient to make firm conclusions. CONCLUSION As a result, more carefully designed RCTs are needed to investigate the effect of probiotics on inflammatory biomarkers and the length of ICU stay in traumatic brain injuries and multiple trauma patients in greater detail.
Collapse
Affiliation(s)
- Nooshin Noshadi
- Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Marzieh Heidari
- Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Mohammad Naemi Kermanshahi
- Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Meysam Zarezadeh
- Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Sarvin Sanaie
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrangiz Ebrahimi-Mameghani
- Nutrition Research Center, Department of Biochemistry and Diet Therapy, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Science, Tabriz, Iran
| |
Collapse
|
7
|
Mayer D, Altvater M, Schenz J, Arif R, Karck M, Leuschner F, Weigand MA, Uhle F, Lichtenstern C. Monocyte Metabolism and Function in Patients Undergoing Cardiac Surgery. Front Cardiovasc Med 2022; 9:853967. [PMID: 35935635 PMCID: PMC9347004 DOI: 10.3389/fcvm.2022.853967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/21/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Cardiopulmonary bypass (CPB) can lead to systemic inflammation, which is associated with higher morbidity. Therefore, we investigated the metabolism of isolated blood monocytes before and after CPB compared to healthy controls. Methods In this prospective, monocentric, observational study, we included 30 patients undergoing CPB and 20 controls. We isolated monocytes from heparinized blood and investigated their metabolism by using Seahorse technology before (t0), 4 h (t4), and 24 h (t24) after the start of the CPB. We also examined programmed cell death 1 ligand (PD-L1), PD-L2, V-domain Ig suppressor of T cell activation (VISTA), and human leukocyte antigen-DR isotype (HLA-DR) using fluorescence-activated cell sorting analysis. Additionally, we investigated plasma cytokine levels in patients without and after ex vivo stimulation. Results CPB-induced inflammatory responses are shown by significantly elevated plasma interleukin-6 levels in the CPB group compared to baseline and controls [t0: 0 ng/ml (95%CI 0-0 ng/ml); t4: 0.16 ng/ml (95%CI 0.1-0.197 ng/ml), p < 0.0001; t24: 0.11 ng/ml (95% CI 0.1-0.16 ng/ml), p < 0.0001, and controls: 0 ng/ml (95% CI 0-0 ng/ml)]. The cytokine release in the ex vivo stimulation is reduced for lipopolysaccharide stimulation at t4 [t0: 35.68 ng/ml (95% CI 22.17-46.57 ng/ml) vs. t4: 15.02 (95% CI 10.25-24.78 ng/ml), p < 0.0001]. Intracellular metabolism of monocytes after CPB showed a protracted shift to aerobic glycolysis [t0: 179.2 pmol/min (95% CI 138.0-205.1 pmol/min) vs. t24: 250.1 pmol/min (95% CI 94.8-300.2 pmol/min), p < 0.0001]. Additionally, we observed an altered metabolism in monocytes in patients undergoing cardiac surgery compared to controls even before any surgical procedure [t0: 179.2 pmol/min (95% CI 138.0-205.1) vs. controls 97.4 (95% CI 59.13-144.6 pmol/min), p = 0.0031]. Conclusion After CPB, patients' monocytes show a shift in metabolism from oxidative phosphorylation to aerobic glycolysis, which is associated with energy-demanding and proinflammatory processes. This is the first study to show changes in monocyte immunometabolism in cardiac surgery. Monocytes of patients undergoing cardiac surgery were leaning toward aerobic glycolysis even before any surgical procedure was conducted. Leaving the question of the pathophysiological mechanisms for future studies to be investigated and paving the way for potential therapy approaches preventing inflammatory effects of CPB.
Collapse
Affiliation(s)
- Daniel Mayer
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc Altvater
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Judith Schenz
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Leuschner
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A. Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Uhle
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Lichtenstern
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
- *Correspondence: Christoph Lichtenstern
| |
Collapse
|
8
|
Fouladseresht H, Ghamar Talepoor A, Eskandari N, Norouzian M, Ghezelbash B, Beyranvand MR, Nejadghaderi SA, Carson-Chahhoud K, Kolahi AA, Safiri S. Potential Immune Indicators for Predicting the Prognosis of COVID-19 and Trauma: Similarities and Disparities. Front Immunol 2022; 12:785946. [PMID: 35126355 PMCID: PMC8815083 DOI: 10.3389/fimmu.2021.785946] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022] Open
Abstract
Although cellular and molecular mediators of the immune system have the potential to be prognostic indicators of disease outcomes, temporal interference between diseases might affect the immune mediators, and make them difficult to predict disease complications. Today one of the most important challenges is predicting the prognosis of COVID-19 in the context of other inflammatory diseases such as traumatic injuries. Many diseases with inflammatory properties are usually polyphasic and the kinetics of inflammatory mediators in various inflammatory diseases might be different. To find the most appropriate evaluation time of immune mediators to accurately predict COVID-19 prognosis in the trauma environment, researchers must investigate and compare cellular and molecular alterations based on their kinetics after the start of COVID-19 symptoms and traumatic injuries. The current review aimed to investigate the similarities and differences of common inflammatory mediators (C-reactive protein, procalcitonin, ferritin, and serum amyloid A), cytokine/chemokine levels (IFNs, IL-1, IL-6, TNF-α, IL-10, and IL-4), and immune cell subtypes (neutrophil, monocyte, Th1, Th2, Th17, Treg and CTL) based on the kinetics between patients with COVID-19 and trauma. The mediators may help us to accurately predict the severity of COVID-19 complications and follow up subsequent clinical interventions. These findings could potentially help in a better understanding of COVID-19 and trauma pathogenesis.
Collapse
Affiliation(s)
- Hamed Fouladseresht
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atefe Ghamar Talepoor
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Eskandari
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Norouzian
- Department of Laboratory Sciences, School of Allied Medical Sciences, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Behrooz Ghezelbash
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Beyranvand
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- *Correspondence: Mohammad Reza Beyranvand,
| | - Seyed Aria Nejadghaderi
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Kristin Carson-Chahhoud
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Safiri
- Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
9
|
Meier MP, Bauer IJ, Maheshwari AK, Husen M, Jäckle K, Hubert J, Hawellek T, Lehmann W, Saul D. Predicting the Exception-CRP and Primary Hip Arthroplasty. J Clin Med 2021; 10:4985. [PMID: 34768504 PMCID: PMC8584609 DOI: 10.3390/jcm10214985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND While primary hip arthroplasty is the most common operative procedure in orthopedic surgery, a periprosthetic joint infection is its most severe complication. Early detection and prediction are crucial. In this study, we aimed to determine the value of postoperative C-reactive protein (CRP) and develop a formula to predict this rare, but devastating complication. METHODS We retrospectively evaluated 708 patients with primary hip arthroplasty. CRP, white blood cell count (WBC), and several patient characteristics were assessed for 20 days following the operative procedure. RESULTS Eight patients suffered an early acute periprosthetic infection. The maximum CRP predicted an infection with a sensitivity and specificity of 75% and 56.9%, respectively, while a binary logistic regression reached values of 75% and 80%. A multinominal logistic regression, however, was able to predict an early infection with a sensitivity and specificity of 87.5% and 78.9%. With a one-phase decay, 71.6% of the postoperative CRP-variance could be predicted. CONCLUSION To predict early acute periprosthetic joint infection after primary hip arthroplasty, a multinominal logistic regression is the most promising approach. Including five parameters, an early infection can be predicted on day 5 after the operative procedure with 87.5% sensitivity, while it can be excluded with 78.9% specificity.
Collapse
Affiliation(s)
- Marc-Pascal Meier
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, 37075 Göttingen, Germany; (M.-P.M.); (I.J.B.); (K.J.); (T.H.); (W.L.)
| | - Ina Juliana Bauer
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, 37075 Göttingen, Germany; (M.-P.M.); (I.J.B.); (K.J.); (T.H.); (W.L.)
| | - Arvind K. Maheshwari
- Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Martin Husen
- Department of Orthopedic Surgery, Rochester, MN 55905, USA;
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, 45147 Essen, Germany
| | - Katharina Jäckle
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, 37075 Göttingen, Germany; (M.-P.M.); (I.J.B.); (K.J.); (T.H.); (W.L.)
| | - Jan Hubert
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, 20521 Hamburg, Germany;
| | - Thelonius Hawellek
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, 37075 Göttingen, Germany; (M.-P.M.); (I.J.B.); (K.J.); (T.H.); (W.L.)
| | - Wolfgang Lehmann
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, 37075 Göttingen, Germany; (M.-P.M.); (I.J.B.); (K.J.); (T.H.); (W.L.)
| | - Dominik Saul
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, 37075 Göttingen, Germany; (M.-P.M.); (I.J.B.); (K.J.); (T.H.); (W.L.)
- Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN 55905, USA;
| |
Collapse
|
10
|
López R, Martí-Chillón GJ, Blanco JF, da Casa C, González-Robledo J, Pescador D, Preciado S, Muntión S, Sánchez-Guijo F. MSCs from polytrauma patients: preliminary comparative study with MSCs from elective-surgery patients. Stem Cell Res Ther 2021; 12:451. [PMID: 34380565 PMCID: PMC8356428 DOI: 10.1186/s13287-021-02500-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Polytrauma is a major clinical problem due to its impact on morbidity and mortality, especially among the younger population. Its pathophysiology is not completely elucidated, and the study of the involvement of certain cell populations with therapeutic potential, such as mesenchymal stromal cells (MSCs), is an area of growing interest, as mesenchymal cells have anti-inflammatory, immunoregulatory, and osteogenic potential. Methods In the present preliminary work, we have evaluated the characteristics of MSCs in terms of proliferation, immunophenotype, cell cycle, clonogenic capacity, and multilineage differentiation ability in a series of 18 patients with polytrauma and compared them to those from otherwise healthy patients undergoing elective spinal surgery. Results MSCs from polytrauma patients displayed higher proliferative potential with significantly higher cumulative population doublings, increased expression of some important cell adhesion molecules (CD105, CD166), and an early pre-osteogenic differentiation ability compared to those of the control group. Conclusions MSCs could potentially be of help in the repair process of polytrauma patients contribute to both cell-tissue repair and anti-inflammatory response. This potential should be further explored in larger studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-021-02500-9.
Collapse
Affiliation(s)
- Raúl López
- Orthopaedic Surgery and Traumatology Department, University Hospital of Salamanca, Salamanca, Spain
| | | | - Juan F Blanco
- Orthopaedic Surgery and Traumatology Department, University Hospital of Salamanca, Salamanca, Spain. .,Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain. .,Universidad de Salamanca (USAL), Salamanca, Spain. .,TerCel Network, ISCIII, Madrid, Spain.
| | - Carmen da Casa
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | | | - David Pescador
- Orthopaedic Surgery and Traumatology Department, University Hospital of Salamanca, Salamanca, Spain.,Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Silvia Preciado
- Haematology Department, University Hospital of Salamanca, Salamanca, Spain.,Network Center in Regenerative Medicine and Cellular Therapy of Castilla y León, Salamanca, Spain
| | - Sandra Muntión
- Haematology Department, University Hospital of Salamanca, Salamanca, Spain.,TerCel Network, ISCIII, Madrid, Spain.,Network Center in Regenerative Medicine and Cellular Therapy of Castilla y León, Salamanca, Spain
| | - Fermín Sánchez-Guijo
- Haematology Department, University Hospital of Salamanca, Salamanca, Spain.,Universidad de Salamanca (USAL), Salamanca, Spain.,TerCel Network, ISCIII, Madrid, Spain.,Network Center in Regenerative Medicine and Cellular Therapy of Castilla y León, Salamanca, Spain
| |
Collapse
|
11
|
Weber B, Lackner I, Braun CK, Kalbitz M, Huber-Lang M, Pressmar J. Laboratory Markers in the Management of Pediatric Polytrauma: Current Role and Areas of Future Research. Front Pediatr 2021; 9:622753. [PMID: 33816396 PMCID: PMC8010656 DOI: 10.3389/fped.2021.622753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
Severe trauma is the most common cause of mortality in children and is associated with a high socioeconomic burden. The most frequently injured organs in children are the head and thorax, followed by the extremities and by abdominal injuries. The efficient and early assessment and management of these injuries is essential to improve patients' outcome. Physical examination as well as imaging techniques like ultrasound, X-ray and computer tomography are crucial for a valid early diagnosis. Furthermore, laboratory analyses constitute additional helpful tools for the detection and monitoring of pediatric injuries. Specific inflammatory markers correlate with post-traumatic complications, including the development of multiple organ failure. Other laboratory parameters, including lactate concentration, coagulation parameters and markers of organ injury, represent further clinical tools to identify trauma-induced disorders. In this review, we outline and evaluate specific biomarkers for inflammation, acid-base balance, blood coagulation and organ damage following pediatric polytrauma. The early use of relevant laboratory markers may assist decision making on imaging tools, thus contributing to minimize radiation-induced long-term consequences, while improving the outcome of children with multiple trauma.
Collapse
Affiliation(s)
- Birte Weber
- Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - Ina Lackner
- Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - Christian Karl Braun
- Institute of Clinical and Experimental Trauma-Immunology, University Hospital of Ulm, Ulm, Germany.,Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Miriam Kalbitz
- Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma-Immunology, University Hospital of Ulm, Ulm, Germany
| | - Jochen Pressmar
- Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| |
Collapse
|
12
|
Bahloul M, Dlela M, Bouchaala K, Kallel H, Ben Hamida C, Chelly H, Bouaziz M. Post-traumatic pulmonary embolism: incidence, physiopathology, risk factors of early occurrence, and impact outcome. A narrative review. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2020; 10:432-443. [PMID: 33224594 PMCID: PMC7675152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a well-established complication of trauma. So far, the factors that are related to early post-traumatic pulmonary embolism (PE) occurrence have been given little attention. AIMS We have conducted this literature review in order to analyze the incidence and the physiopathology of post-traumatic PE among intensive care unit (ICU) trauma patients, analyze the incidence of early post-traumatic PE, and elucidate risk factors associated with post-traumatic PE. Moreover, we aim to study the impact/outcome of post-traumatic PE in the ICU. METHODS We used the PubMed and EMBASE databases and entered the following key words in MeSH research: Deep vein thrombosis (DVT), Post-traumatic Pulmonary embolism, Early pulmonary-embolism, risk factors, and Prognosis. RESULTS The incidence of PE among trauma patients varies considerably, ranging from 0.35% to 24%. The incidence of early post-traumatic PE varies widely from 10 to 42%. After a traumatic injury, many factors have been found to be responsible for the formation of DVT and PE. In addition to the risk factors of hypercoagulability described by Virchow in his original triad, inflammation acting via endothelial damage may be considered as a fourth factor. The literature review showed that lower limb fractures and age are the most frequent factors associated with PE (particularly in early PE). The heterogeneity among studies limits reliable conclusions regarding the true risk factors for the timing of the occurrence of post-traumatic PE. Fatality from pulmonary embolism (PE) is close to 50% in some series. Moreover, high mortality rates, a high rate of nosocomial infections, and a prolonged stay in an ICU and/or in a hospital were found to be associated with the development of PE. CONCLUSION Post-traumatic PE is frequent in ICUs. Inflammation acting via endothelial damage may be considered as a fourth factor in addition to the Virchow's triad of risk factors for venous thrombosis. Fractures of the lower extremities, obesity, and age happen to be the most frequent factors associated with PE (in particular early PE). PE development was associated with high rates of mortality, nosocomial infections, and a prolonged stay in an ICU and/or in a hospital. Therefore, prevention is warranted.
Collapse
Affiliation(s)
- Mabrouk Bahloul
- Department of Intensive Care, Habib Bourguiba University Hospital, Faculté de Medicine de Sfax, Sfax University Sfax, Tunisia
| | - Mariem Dlela
- Department of Intensive Care, Habib Bourguiba University Hospital, Faculté de Medicine de Sfax, Sfax University Sfax, Tunisia
| | - Karama Bouchaala
- Department of Intensive Care, Habib Bourguiba University Hospital, Faculté de Medicine de Sfax, Sfax University Sfax, Tunisia
| | - Hela Kallel
- Department of Intensive Care, Habib Bourguiba University Hospital, Faculté de Medicine de Sfax, Sfax University Sfax, Tunisia
| | - Chokri Ben Hamida
- Department of Intensive Care, Habib Bourguiba University Hospital, Faculté de Medicine de Sfax, Sfax University Sfax, Tunisia
| | - Hedi Chelly
- Department of Intensive Care, Habib Bourguiba University Hospital, Faculté de Medicine de Sfax, Sfax University Sfax, Tunisia
| | - Mounir Bouaziz
- Department of Intensive Care, Habib Bourguiba University Hospital, Faculté de Medicine de Sfax, Sfax University Sfax, Tunisia
| |
Collapse
|
13
|
Tylicka M, Matuszczak E, Hermanowicz A, Dębek W, Karpińska M, Kamińska J, Koper-Lenkiewicz OM. BDNF and IL-8, But Not UCHL-1 and IL-11, Are Markers of Brain Injury in Children Caused by Mild Head Trauma. Brain Sci 2020; 10:brainsci10100665. [PMID: 32987792 PMCID: PMC7598703 DOI: 10.3390/brainsci10100665] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 11/27/2022] Open
Abstract
The aim of the study was to check whether the plasma levels of brain-derived neurotrophic factor (BDNF), interleukin-8 (IL-8), interleukin-11 (IL-11) and ubiquitin C-terminal hydrolase L1 (UCHL-1) change in children with mild head trauma (N = 29) compared to controls (N = 13). Protein concentration in children with mild head trauma (12 children with mild concussion without loss of consciousness and 17 children with severe concussion and loss of consciousness) and the control group were measured by means of the Enzyme-Linked Immunosorbent Assay (ELISA) method. IL-8 and BDNF concentration was statistically higher in the group of children with mild head trauma (9.89 pg/mL and 2798.00 pg/mL, respectively) compared to the control group (7.52 pg/mL and 1163.20 pg/mL, respectively). BDNF concentration was significantly higher in children with severe concussion and loss of consciousness (3826.00 pg/mL) than in the control group. None of the tested proteins differed significantly between children with mild concussion without loss of consciousness and children with severe concussion and loss of consciousness. BDNF and IL-8 may be sensitive markers of brain response to mild head trauma in children. The lack of statistical differences for BDNF and IL-8 between children with mild or severe concussion could indicate that their elevated levels may not result from significant structural brain damage but rather reflect a functional disturbance.
Collapse
Affiliation(s)
- Marzena Tylicka
- Department of Biophysics, Medical University of Białystok, Mickiewicza 2a, 15-089 Białystok, Poland;
- Correspondence: (M.T.); (O.M.K.-L.)
| | - Ewa Matuszczak
- Department of Pediatric Surgery and Urology, Medical University of Białystok, Waszyngtona 17, 15-274 Białystok, Poland; (E.M.); (A.H.); (W.D.)
| | - Adam Hermanowicz
- Department of Pediatric Surgery and Urology, Medical University of Białystok, Waszyngtona 17, 15-274 Białystok, Poland; (E.M.); (A.H.); (W.D.)
| | - Wojciech Dębek
- Department of Pediatric Surgery and Urology, Medical University of Białystok, Waszyngtona 17, 15-274 Białystok, Poland; (E.M.); (A.H.); (W.D.)
| | - Maria Karpińska
- Department of Biophysics, Medical University of Białystok, Mickiewicza 2a, 15-089 Białystok, Poland;
| | - Joanna Kamińska
- Department of Clinical Laboratory Diagnostics, Medical University of Białystok, Waszyngtona 15A, 15-269 Białystok, Poland;
| | - Olga Martyna Koper-Lenkiewicz
- Department of Clinical Laboratory Diagnostics, Medical University of Białystok, Waszyngtona 15A, 15-269 Białystok, Poland;
- Correspondence: (M.T.); (O.M.K.-L.)
| |
Collapse
|
14
|
Apple CG, Miller ES, Loftus TJ, Kannan KB, Parvataneni HK, Hagen JE, Efron PA, Mohr AM. Impact of Injury Severity on the Inflammatory State and Severe Anemia. J Surg Res 2019; 248:109-116. [PMID: 31881381 DOI: 10.1016/j.jss.2019.10.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/14/2019] [Accepted: 10/22/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Severe traumatic injury is a major cause of morbidity and mortality. Our goal was to analyze blunt traumatic injury by injury severity score (ISS) and compare with elective hip repair, as a transient injury, and healthy control with the hypothesis that more severe injury would lead to an increase in neuroendocrine activation, systemic inflammation, and worse anemia. MATERIALS AND METHODS A prospective observational cohort study was performed at a level 1 trauma center, comparing blunt trauma patients (n = 37), elective hip replacement patients (n = 26), and healthy controls (n = 8). Bone marrow and plasma were assessed for hyperadrenergic state, erythropoiesis, and systemic inflammation. Trauma patient's ISS ranged from 4 to 41 and were broken down into quartiles for analysis. The ISS quartiles were 4-13, 14-20, 21-26, and 27-41. RESULTS Plasma norepinephrine, interleukin-6, tumor necrosis factor-alpha, and hepcidin increased progressively as ISS increased. Hemoglobin significantly decreased as ISS increased and packed red blood cell (pRBC) transfusion increased as ISS increased. Elective hip replacement patients had an appropriate increase in the bone marrow expression of erythropoietin and the erythropoietin receptor, which was absent in all trauma patient groups. CONCLUSIONS Increased neuroendocrine activation, systemic inflammation, and anemia correlated with worsening injury severity, lower age, and increased pRBC transfusions. Elective hip replacement patients have only minimal systemic inflammation with an appropriate bone marrow response to anemia. This study demonstrates a link between injury severity, neuroendocrine activation, systemic inflammation, and the bone marrow response to anemia.
Collapse
Affiliation(s)
- Camille G Apple
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida Health, Gainesville, Florida
| | - Elizabeth S Miller
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida Health, Gainesville, Florida
| | - Tyler J Loftus
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida Health, Gainesville, Florida
| | - Kolenkode B Kannan
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida Health, Gainesville, Florida
| | - Hari K Parvataneni
- Department of Orthopedic Surgery, University of Florida, Gainesville, Florida
| | - Jennifer E Hagen
- Department of Orthopedic Surgery, University of Florida, Gainesville, Florida
| | - Philip A Efron
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida Health, Gainesville, Florida
| | - Alicia M Mohr
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida Health, Gainesville, Florida.
| |
Collapse
|
15
|
Effect of Beta-Blockade on the Expression of Regulatory MicroRNA after Severe Trauma and Chronic Stress. J Am Coll Surg 2019; 230:121-129. [PMID: 31672639 DOI: 10.1016/j.jamcollsurg.2019.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/14/2019] [Accepted: 09/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Beta-blockade administration after lung contusion, hemorrhagic shock, and chronic stress has been shown to improve bone marrow function, decrease hypercatecholaminemia, and reduce inflammation. MicroRNAs (miR) are critical biologic regulators that can downregulate gene expression by causing messenger RNA degradation or inhibition of translation. This study sought to expand our understanding of the molecular mechanisms underlying the reduced inflammatory response after the administration of beta-blockade (BB) in our rodent trauma model. STUDY DESIGN Male Sprague-Dawley rats aged 8 to 9 weeks were randomized to lung contusion, hemorrhagic shock with daily restraint stress (LCHS/CS) or LCHS/CS plus propranolol (LCHS/CS+BB). Restraint stress occurred 2 hours daily after LCHS. Propranolol (10 mg/kg) was given daily until day 7. Total RNA and miR were isolated from bone marrow and genome-wide miR expression patterns were assayed. Bone marrow cytokine expression was determined with quantitative polymerase chain reaction. RESULTS LCHS/CS led to significantly increased bone marrow expression of interleukin (IL) 1β, tumor necrosis factor-α, IL-6, nitric oxide, and plasma C-reactive protein. There were marked differences in expression of 45 miRs in the LCHS/CS+BB group compared with the LCHS/CS group when using a p value <0.001. Rno-miR-27a and miR-25 were upregulated 7- to 8-fold in the rodents who underwent LCHS/CS+BB compared with LCHS/CS alone, and this correlated with reduced bone marrow expression of IL-1β, tumor necrosis factor-α, IL-6, nitric oxide, and reduced plasma C-reactive protein in the LCHS/CS+BB group. CONCLUSIONS The genomic and miR expression patterns in bone marrow after LCHS/CS differed significantly compared with rodents that received propranolol after LCHS/CS. The use of BB after severe trauma can help mitigate persistent inflammation by upregulating Rno-miR-27a and miR-25 and reducing inflammatory cytokines in those who remain critically ill.
Collapse
|