Background:Recent international researches in trauma patients have shown that hyperglycemia usually goes along with increased mortality, ventilator time and post-operative complications. The role of blood glucose in trauma prognosis and treatment is a current concern. Objective: To evaluate blood glucose change and the relationship of hyperglycemia to severity of injury in the clinical in multiple trauma patients before operation. Subjects and method: A prospective, descriptive study was conducted at the Emergency Surgery Unit and Post-anesthesia Care Unit, Department of Anesthesia and Recovery, Viet Duc hospital, from March to September/2006. The participants were over 15 years old, multiple trauma patients who were operated within 48 hours after the accident, but they had not been used inotrope, sedatives and operated in other clinical. Results: Hypoglycemia (under 3.5 mmol/l) was seen in 4/926 multiple trauma patients. Three of four were in shock due to severe blood loss, of which 2 patients had breath and cardiac arrest. Both patients died from multi-organ dysfunction immediately and one week after operation. The average blood glucose level of patients with ISS 25-40 and over 40 was significantly higher than those with ISS 16-24. Hyperglycemia had a closely positive association with ISS (r=0.48, p< 0.01). Conclusion: Most of multiple trauma patients have hyperglycemia before operation. Hyperglycemia has a relationship with severity of injury, especially with severity of anatomical injury. 4.1% patients have hypoglycemia which is mainly associative with prolonged shock.
Multiple Trauma/ blood ; surgery ; Hyperglycemia/ pathology ; therapy

OBJECTIVE: To explore the application value of postmortem multi-slice spiral computed tomography (MSCT) in cases of fall from height through observing and analyzing the injury features of the fall and reconstructing the process of the fall based on the the above procedure. METHODS: One real fatal case due to fall from height was fully examined using MSCT and three-dimensional reconstruction technique. Analyzing the manner and cause of death through combination of MSCT and systemic autopsy was also implemented. The differences between autopsy and MSCT in getting information of injuries were compared. RESULTS: Fractures involving multiple body regions and liver rupture were found through MSCT and three-dimensional reconstruction. The autopsy got the same results with imageological examination. The case of death was deduced to be fall leading to systemic polytrauma. CONCLUSION Application of MSCT can be used as the complimentary for traditional autopsy in the analysis of injury manner of fall from height.
Autopsy ; Death ; Forensic Pathology ; Fractures, Bone ; Humans ; Multiple Trauma ; Tomography, Spiral Computed

BACKGROUNDIt is important to study the factors affecting the clinical mortality of the severe multiple trauma population. The present study was aimed to identify the potential risk factors that could affect mortality rate of acute lung injury (ALI) in severely injured multiple trauma population and to investigate the effects of certain risk factors on the prognosis of different patient subpopulations.

METHODSThis is a follow-up study treating trauma as a single cause for emergency department (ED) and emergency intensive care unit (EICU) admissions. Patients identified with severe multiple trauma with early onset of ALI were enrolled from five trauma centers. Nineteen potential risk factors affecting the prognosis of ALI were examined by univariate and multivariate Logistic regression analyses to identify the ones that affected the mortality of these severe multiple trauma patients.

RESULTSThere were 687 multiple trauma patients with post-traumatic ALI admitted to ED and EICU during the study period. The six risk factors that affected the mortality with unadjusted odd ratios (ORs) and 95% confidence intervals (CIs) were Acute Physiology Score and Chronic Health Evaluation Score (APACHE) II score, Injury Severity Score (ISS), duration of trauma, age, aspiration of gastric contents, and disseminated intravascular coagulation (DIC). Specific risk factors also affected different patient subpopulations at different degrees (surviving beyond 24 hours, 72 hours, 28 days and with multiple blood transfusions and higher injury scores).

CONCLUSIONSFactors of APACHE II score, ISS and aspiration of gastric contents that could predict the mortality of ALI may exist in the early stage of trauma. Duration of trauma and DIC that greatly affected and predicted the short- and long-term development and mortality of ALI deserve special attention. Elderly patients (aged beyond 65 years) were the independent risk factor for the secondary sepsis and deterioration of pulmonary function. Patients with these risk factors need aggressive supportive care as early as possible in order to prevent further aggravation.

APACHE ; Acute Lung Injury ; mortality ; pathology ; Adult ; Confidence Intervals ; Female ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Multiple Trauma ; mortality ; pathology ; Odds Ratio ; Risk Factors

OBJECTIVE: To investigate the changes of iron content in serum and liver, ferritin content in serum, percentage of myeloperoxidase (MPO) positive granulocyte in rabbits after different serious trauma and to explore the relationship between these changes and multiple organ failure (MOF). METHODS: Rabbit trauma models were established. Iron content in serum and liver, ferritin content in serum and the percentage of MPO positive granulocyte were measured at different time after trauma. RESULTS: After trauma, iron content in serum decreased sharply in early period (12-36h) and increased gradually to normal level in mild traumatic group after 60 h. Iron content in serum remained lower level in severe traumatic and death group 60 h after trauma. Iron content in liver obviously increased in death group. The changes of ferritin content in serum in mild traumatic were not obvious. Ferritin contents in serum in severe injury group and death group were slightly higher in early period and decreased in later period. The percentage of MPO positive granulocyte increased in early period after trauma. The percentage began to decrease 6 d after trauma and returned to normal level in mild traumatic group. The percentage obviously was significantly lower than normal levels in severe traumatic group and death group 6 d after trauma. Some rabbits died 60 h-6 d after severe trauma, and the pathological changes in the other organs were consistent with MOF. CONCLUSION Trauma can cause the serum iron, ferritin levels and percentage of MPO positive granulocyte changes. Severe trauma can cause uncompensated changes of these indicators, which could be the main mechanisms of MOF and death.
Animals ; Disease Models, Animal ; Ferritins/metabolism* ; Injury Severity Score ; Iron/metabolism* ; Leukocyte Count ; Liver/metabolism* ; Male ; Multiple Organ Failure/pathology* ; Multiple Trauma/pathology* ; Peroxidase/metabolism* ; Rabbits ; Time Factors ; Wounds and Injuries/pathology*

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Diagnostic Errors ; Emergency Medical Services ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; diagnosis ; pathology ; Time Factors ; Young Adult

Adolescent ; Adult ; Aged ; Diagnostic Errors ; Female ; Fractures, Bone ; diagnosis ; Humans ; Male ; Middle Aged ; Multiple Trauma ; pathology ; therapy ; Physician's Role ; Young Adult

OBJECTIVETo investigate the stimulating effect of sera from severe multiple trauma patients within 24 h post trauma on nuclear factor-kappaB (NF-kappaB) activity in macrophage and their relationship with patients prognosis.

METHODSPeripheral blood of 47 patients with multiple traumas with injury severity score (ISS) > or = 16 and 24 healthy volunteers were obtained, and sera samples were isolated. And 24 h after transfection of the recombinant NF-kappaB plasmid containing luciferase reporter gene into the mouse macrophage line (RAW 264.7), the cells were stimulated by sera from different patients for 6 h, then stimulating effect of sera on NF-kappaB was assessed by luciferase activity. The concentrations of interleukin-1 beta, tumor necrosis factor alpha, interleukin-10, interleukin-1 receptor antagonist, and soluble tumor necrosis factor receptor I were detected with ELISA kits.

RESULTSThe stimulating activity of sera from trauma patients on NF-kappaB was increased significantly, and it was higher in MODS group, non-survivor group than that in non-MODS, survivor group respectively. The level of activity was correlated positively with APACHE II score, while it did not have relationship to the cytokine or endogenous antagonist levels. The area under the receiver operating characteristic curve (ROC) of NF-kappaB activity for predicting MODS and mortality was significantly higher than that of APACHE II score.

CONCLUSIONEarly measurement of NF-kappaB stimulating activity of sera from severe multiple trauma patients may have the value to predict occurrence of MODS and mortality.

Adolescent ; Adult ; Animals ; Cell Line ; Female ; Humans ; Macrophages ; metabolism ; Male ; Mice ; Middle Aged ; Multiple Organ Failure ; blood ; pathology ; Multiple Trauma ; blood ; NF-kappa B ; metabolism ; Prognosis ; Serum ; Young Adult

OBJECTIVETo comparatively study the effects and mechanisms of burn-blast combined injury and burn-firearm combined injury complicated with seawater immersion on vascular endothelial cells.

METHODSA total of 40 healthy adult hybrid dogs of both sexes, weighing 12-15 kg, were used in this study. Randomly-selected 20 dogs were established as models of burn-blast combined injury (the burn-blast injury group) and the other 20 dogs as models of burn-firearm combined injury (the burn-firearm injury group). Then the wounds of all the dogs were immediately immersed in seawater for 4 hours, and then they were taken out from the seawater. Blood samples were withdrawn from the central vein of the dogs before injury, and at 4, 7, 10, 20, and 28 hours after injury to measure the circulating endothelial cells and the von Willebrand factor.

RESULTSCirculating endothelial cells increased significantly at 4 hours after injury in all the dogs. But they reached peak at 7 hours after injury in the burn-blast injury group and at 28 hours after injury in the burn-firearm injury group. The changes of circulating endothelial cells in the burn-blast injury group were significantly different from those in the burn-firearm injury group at 4, 7, 20, and 28 hours after injury (P < 0.01). The von Willebrand factor reached peak at 4 hours after injury in the burn-blast injury group and at 28 hours in the burn-firearm injury group. The changes of von Willebrand factor in the burn-blast injury group were significantly different from those in the burn-firearm injury group at 4, 20, and 28 hours after injury (P < 0.01).

CONCLUSIONSIn burn-blast injury combined with seawater immersion, the vascular endothelial cells changed most significantly at 4 hours or 7 hours after injury, while burn-firearm injury combined with seawater immersion have the same at 20 hours or 28 hours after injury.

Animals ; Blast Injuries ; pathology ; physiopathology ; Burns ; pathology ; physiopathology ; Disease Models, Animal ; Dogs ; Endothelial Cells ; physiology ; Female ; Immersion ; Injury Severity Score ; Male ; Multiple Organ Failure ; physiopathology ; Multiple Trauma ; pathology ; physiopathology ; Probability ; Random Allocation ; Seawater ; Sensitivity and Specificity ; Wound Healing ; physiology ; Wounds, Gunshot ; pathology ; physiopathology

OBJECTIVETo investigate the role of autophagy in acute lung injury (ALI) caused by multiple trauma in rats via pretreat with 3-methyladenine (3-MA).

METHODSForty-five Sprague-Dawley male rats, with age of 4 months and body weight of 250-300 g,were randomly divided into three groups. In the sham group, the rats received sphenotresia only;in the control group, the rats were made model of femur shaft fracture combined with brain injury, and treated with physiological saline by abdominal cavity at 1 hour before making model; in the 3-MA group, the rats were made model of femur shaft fracture combined with brain injury,and treated with 3-MA of 10 mg/kg by abdominal cavity at 1 hour before making model. Histologic changes and the concentration of related inflammatory factors in the damaged lung tissue were examined at 48 h after opteration, at the same time, the effect of 3-MA on the expression of LC-3 II and Beclin-1 was examined through reverse transcriptase polymerase chain reaction technique (RT-PCR).

RESULTSCompared with sham group, LC-3 II and Beclin-1 level in control group at 48 h after operation were obviously increased (P < 0.01). Compared with control group, LC-3 II and Beclin-1 level in 3-MA group at 48 h after operation were obviously decreased (P < 0.01). Compared with sham group, the level of proinflammatory cytokines (TNF-α and IL-6) in control group obviously enhanced (P < 0.01). Compared with control group, above items in 3-MA group was obviously lower (P < 0.01). Compared with control group,the histopathological damage of lung in 3-MA group obviously reduced (P < 0.01).

CONCLUSIONAutophagy can aggravate the acute lung injury caused by fracture of shaft of femur combined with brain injuries,but 3-MA can reduce tissue damage by inhibiting the autophagy and inflammatory response.

Acute Lung Injury ; prevention & control ; Adenine ; analogs & derivatives ; therapeutic use ; Animals ; Apoptosis Regulatory Proteins ; analysis ; Beclin-1 ; Interleukin-6 ; analysis ; Lung ; chemistry ; immunology ; pathology ; Male ; Multiple Trauma ; complications ; Rats ; Rats, Sprague-Dawley ; Tumor Necrosis Factor-alpha ; analysis