European journal of trauma and emergency surgery : official publication of the European Trauma Society
-
This review summarizes a short list of currently discussed trauma-induced danger-associated molecular patterns (DAMP). Due to the bivalent character and often pleiotropic effects of a DAMP, it is difficult to describe its "friend or foe" role in post-traumatic inflammation and regeneration, both systemically as well locally in tissues. ⋯ While in vitro and experimental studies allow for the detection of these biomarkers at the different levels of an organism-cellular, tissue, circulation-this is not always easily transferable to the human setting. Increased knowledge exploring the dual role of DAMP after trauma, and concentrating on their nuclear functions, transcriptional targets, release mechanisms, cellular sources, multiple functions, their interactions and potential therapeutic targeting is warranted.
-
Eur J Trauma Emerg Surg · Jun 2018
ReviewA systematic review of propensity score methods in the acute care surgery literature: avoiding the pitfalls and proposing a set of reporting guidelines.
Propensity score methods are techniques commonly employed in observational research to account for confounding when estimating the effects of treatments and exposures. These methods have been increasingly employed in the acute care surgery literature in an attempt to infer causality; however, the adequacy of reporting and the appropriateness of statistical analyses when using propensity score matching remain unclear. ⋯ We have proposed reporting guidelines for the use of propensity score methods in the acute care surgery literature. This is to help investigators improve the adequacy of reporting and statistical analyses when using observational data to estimate effects of treatments and exposures.
-
Eur J Trauma Emerg Surg · Jun 2018
ReviewMacrophages play an essential role in trauma-induced sterile inflammation and tissue repair.
Severe trauma is accompanied by a profound activation of the immune system. Patients with polytrauma develop systemic inflammatory response syndrome (SIRS) and often sepsis, which contributes substantially to high mortality of this condition. On a cellular level, necrosis and loss of plasma membrane integrity lead to the release of endogenous "damage-associated molecular patterns" (DAMPs) as danger signals, which in turn activate innate immune cells. ⋯ Dysregulated sterile inflammation and defective healing result in chronic inflammatory disease with persistent tissue damage. In this review, we summarize the cellular and molecular mechanisms that lead to activation of sterile inflammation, recruitment of immune cells and initiation of wound healing. We focus on the pivotal role of macrophages played in this context.
-
Fall from heights is high energy injuries and constitutes a fraction of all fall-related trauma evaluations while bearing an increase in morbidity and mortality. We hypothesize that despite advancements in trauma care, the overall survivability has not improved in this subset of trauma patients. ⋯ Level of height fallen is a good predictor of overall outcome and survival. Despite advances in trauma care, death rates remain unchanged. Safety awareness and injury prevention programs are needed to reduce the risk of high-level falls.
-
Eur J Trauma Emerg Surg · Jun 2018
ReviewThe source of cell-free mitochondrial DNA in trauma and potential therapeutic strategies.
Mitochondria play a key role in the pathophysiology of post-injury inflammation. Cell-free mitochondrial DNA (cf-mtDNA) is now understood to catalyse sterile inflammation after trauma. Observations in trauma cohorts have identified high cf-mtDNA in patients with systemic inflammatory response syndrome and multiple organ failure as well as following major surgery. ⋯ Trauma to cells that are rich in mitochondria are believed to release more cf-mtDNA. This review describes the current understanding of the mechanisms of cf-mtDNA release, its systemic effects and the potential therapeutic implications related to its modification. Although current understanding is insufficient to change trauma management, focussed research goals have been identified to pave the way for monitoring and manipulation of cf-mtDNA release and effects in trauma.