Injury
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Trauma causes tissue injury that results in the release of damage associated molecular patterns (DAMPs) and other mediators at the site of injury and systemically. Such mediators disrupt immune system homeostasis and may activate multicellular immune responses with downstream complications such as the development of infections and sepsis. To characterize these alterations, we used time-of-flight mass cytometry to determine how trauma plasma affects normal peripheral blood mononuclear cell (PBMC) activation to gain insights into the kinetics and nature of trauma-induced circulating factors on human immune cell populations. A better understanding of the components that activate cells in trauma may aid in the discovery of therapeutic targets. ⋯ We hypothesized that circulating factors in trauma plasma would induce phenotypic activation of normal human immune cell subsets. Using an unbiased approach, we identified specific changes in immune cell subsets that respond to trauma plasma. Additionally, CD11c+ NK cells expanded in response to DAMPs and LPS, suggesting they may also be responding to similar components in trauma plasma. Collectively, our data demonstrate that the normal PBMC response to trauma plasma involves marked changes in specific subsets of NK and CD8+ T cell populations. Future studies will target the function of these trauma plasma reactive immune cell subsets. These findings have important implications for the field of acute traumatic injuries.
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Osteosynthesis is recommended for Garden I and II femoral neck fracture treatment using parallel partially threaded cannulated screws. Postoperatively, excessive femoral neck shortening (FNS) and posterior tilt of the femoral neck (PTFN) are frequently encountered and are correlated with impaired quality of life and clinical outcomes. We hypothesized that stabilization by parallel partially threaded cannulated screws replacing a posterior partially threaded screw with a fully threaded positioning screw would improve fracture healing without further FNS and PTFN in femoral neck fractures. ⋯ Parallel cannulated screws replacing a posterior partially threaded screw with a fully threaded positioning screw as a length- and angle-stable construct for Garden I or II femoral neck fracture fixation can prevent femoral neck collapse in both the coronal and axial planes.
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Observational Study
Influence of cognitive impairment on mortality, complications and functional outcome after hip fracture: Dementia as a risk factor for sepsis and urinary infection.
To analyze the relation between cognitive impairment on arrival at hospital in patients older than 65 years with a hip fracture, and their mortality, medical and surgical complications, and functional outcomes. ⋯ Cognitive impairment is a risk factor for mortality in patients with a hip fracture. It is also a risk factor for suffering respiratory and urinary tract infection and sepsis. These two late risks factors have not been published previously. Functional recovery is not conditioned by cognitive impairment, although further studies need to be developed to evaluate the actual role of cognitive impairment on postoperative progression of patients.
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Optimal health is demanded for service members in military operations. However, the strains of deployment can result in a deterioration, moreover when combat-related injuries are sustained, affecting level of participation and health related quality of life (HRQOL). Secondary health conditions may occur in time, however existing studies measure coping, level of activity and participation and HRQOL at one point in time. ⋯ service members with combat-related injuries remain stable in level of activity and participation and HRQOL in time and they use adaptive coping strategies.
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The aim of this study is to assess the causes and rates of re-operation in olecranon fractures in adults treated with transosseous suture. ⋯ Transosseous suture with high strength thread is a valid alternative for treating Mayo IIA olecranon fractures in adult patients, decreasing re-operation rates for implant removal. There may be, in a moderate percentage of cases, radiologic diastasis of the posterior cortex at the fracture site, without causing pain nor limiting mobility LEVEL OF EVIDENCE: III.