PURPOSE: The aim of this study was to determine the relationship between the injury severity and pain intensity according to age in patients with extremity injuries. METHODS: Adult patients with an extremity injury who visited the emergency department (ED) from June 1, 2016 to November 31, 2016 were analyzed retrospectively. The major injury was defined as structural damage below the muscle layer, such as muscle, ligament, and bone. Minor injury group and major injury group were separated according to this definition. The relationship of age and pain score assessed with the numerical rating scale (NRS) with the injury severity was analyzed. RESULTS: Of a total of 1,441 patients, the number of patients with a minor and major injury was 854 (59.3%) and 587 (40.7%), respectively. The proportion of patients aged 65 and older was 6.1% and 25.7% in the minor and major injury group, respectively. Age and NRS scale showed significantly positive associations with the injury severity (p < 0.001). In all NRS scores, the overall proportion of major injuries in the older age group was higher than that in the younger age group. Regardless of the younger ( < 65 years) or older (≥65 years) age group, the NRS score was positively related to the injury severity (young age group [odds ratio, 3.944]; older age group [odds ratio, 5.754]). CONCLUSION: The pain intensity is positively related to the severity of injury regardless of age. The pain intensity is the important factor of a patient assessment and treatment in the emergency department.
Adult ; Emergency Service, Hospital ; Extremities* ; Humans ; Ligaments ; Pain Measurement ; Retrospective Studies ; Trauma Severity Indices

Excessive microglial cell activation is related to the progression of chronic neuro-inflammatory disorders. Heme oxygenase-1 (HO-1) expression mediated by the NFE2-related factor (Nrf-2) pathway is a key regulator of neuro-inflammation. Nardostachys chinensis is used as an anti-malarial, anti-nociceptive, and neurotrophic treatment in traditional Asian medicines. In the present study, we examined the effects of an ethyl acetate extract of N. chinensis (EN) on the anti-neuro-inflammatory effects mediated by HO-1 up-regulation in Salmonella lipopolysaccharide (LPS)- or Staphylococcus aureus lipoteichoic acid (LTA)-stimulated BV2 microglial cells. Our results indicated that EN suppressed pro-inflammatory cytokine production and induced HO-1 transcription and translation through Nrf-2/antioxidant response element (ARE) signaling. EN markedly inhibited LPS- and LTA-induced activation of nuclear factor-kappa B (NF-κB) as well as phosphorylation of mitogen-activated protein kinases (MAPKs) and signal transducer and activator of transcription (STAT). Furthermore, EN protected hippocampal HT22 cells from indirect neuronal toxicity mediated by LPS- and LTA-treated microglial cells. These results suggested that EN impairs LPS- and LTA-induced neuro-inflammatory responses in microglial cells and confers protection against indirect neuronal damage to HT22 cells. In conclusion, our findings indicate that EN could be used as a natural anti-neuro-inflammatory and neuroprotective agent.
Anti-Inflammatory Agents ; pharmacology ; Cell Line ; Heme Oxygenase-1 ; genetics ; immunology ; Humans ; Lipopolysaccharides ; adverse effects ; Microglia ; cytology ; drug effects ; immunology ; Mitogen-Activated Protein Kinases ; genetics ; immunology ; NF-kappa B ; genetics ; immunology ; Nardostachys ; chemistry ; Neuroprotective Agents ; pharmacology ; Plant Extracts ; pharmacology ; Teichoic Acids ; adverse effects