OBJECTIVE: Several scoring systems have been developed to identify patients who require massive transfusion (MT) after major trauma to improve survival. The primary goal of this study was to investigate the usefulness of enhanced computed tomography attenuation values (CTAVs) of major vessels to determine the need for MT in patients with major blunt trauma.METHODS: This single-center retrospective cohort study evaluated patients aged 16 years or older who underwent contrast-enhanced computed tomography scan of the torso after major blunt trauma. The CTAVs of six major vessel points in both the arterial and portal venous phases at initial computed tomography examination were assessed and compared between the MT and the no MT group. The capability of enhanced CTAVs to predict the necessity for MT was estimated based on the area under the receiver operating characteristic curve.RESULTS: Of the 254 eligible patients, 36 (14%) were in the MT group. Patients in the MT group had significantly higher CTAVs at all sites except the inferior vena cava in both the arterial and portal venous phases than that in the no MT group. The descending aorta in the arterial phase had the highest accuracy for predicting MT, with an AUROC of 0.901 (95% confidence interval, 0.855 to 0.947; P<0.001).CONCLUSION: Initial elevation of enhanced CTAV of the aorta is a predictor for the need for MT. A higher CTAV of the aorta should alert the trauma surgeon or emergency physician to activate their MT protocol.
Aorta ; Aorta, Thoracic ; Cohort Studies ; Emergencies ; Humans ; Retrospective Studies ; ROC Curve ; Torso ; Vena Cava, Inferior ; Wounds and Injuries

Patients frequently visit the emergency room with acute chest pain. While some potentially life-threatening disorders may cause the pain, in approximately 80% of cases, the chest pain source is benign, and musculoskeletal chest pain accounts for nearly 20%– 50% of those cases.[1–6] Thus, pain caused by benign and pathological conditions of the chest wall encountered in the emergency department is sometimes incorrectly attributed to angina pectoris or pleuritic and other serious cardiopulmonary diseases.

Objective To compare the ability of the polysaccharide from various Porphyromonas gingivalis(Pg) type and clinical strains in inducing THP-1 cells to produce cytokines interleukin (IL)-1 β,IL-8,and tumor necrosis factor (TNF)-or,in order to analyze the immunogenicity of Pg polysaccharide components and the virulence-associated factors of this periodontal pathogen.Methods The bacterial polysaccharide was extracted from high virulent Pg strains,W83,SJD2,SJD12 and low virulent Pg,ATCC33277,SJD4,SJD5,and SJD11 by phenol-water extraction.The extracted polysaccharide was used to stimulate the THP-1 cells with different simulation periods and doses.The level of the cytokines,including IL-1 β,IL-8 and TNF-α in the cell culture suspension was measured by enzyme-linked immunosorbent assay (ELISA).Results The polysaccharide extraction of Pg strains was composed of lipopolysaccharide (LPS) and capsular polysaccharide.The secretion of IL-1 β,IL-8 and TNF-α,produced by the THP-1 cells showed in a time-and dose-dependent manner in the medium containing 10％ fetal bovine serum.The level of these cytokines of the high virulent strains was higher than that of the low virulent strains in medium containing 1％ fetal bovine serum.Four hours after stimulation with polysaccharide extracted from high virulent strains,the levels of IL-1β,IL-8,and TNF-α in the cell suspension were (1 639 ± 497),(1 648 ± 513) and (140 ±48) μg/L,respectively,whereas for low virulent strains,the levels of IL-1β,IL-8,and TNF-o were (773 ±382),(892 ± 400) and (67 ± 33) μg/L,respectively.Conclusions Polysaccharide extracted from Pg could induced the THP-1 cells to secrete the cytokines of IL-1β,IL-8 and TNF-α.The level of the cytokines produced by the THP-1 cells associates with the bacterial virulent properties.