OBJECTIVE:: To determine the impact of the increasing aging population on trauma mortality relative to mortality from cancer and heart disease in the United States. BACKGROUND:: The population in the United States continues to increase as medical advancements allow people to live longer. The resulting changes in the leading causes of death have not yet been recognized. METHODS:: Data were obtained (2000-2010) from the Web-based Injury Statistics Query and Reporting System database of the Centers for Disease Control and Prevention. We defined trauma deaths as unintentional injuries, suicides, and homicides. RESULTS:: From 2000 to 2010, the US population increased by 9.7% and the number of trauma deaths increased by 22.8%. Trauma deaths and death rates deceased in individuals younger than 25 years but increased for those 25 years and older. During this period, death rates for cancer and heart disease decreased. The largest increases in trauma deaths were in individuals in their fifth and sixth decades of life. Since 2000, the largest proportional increase (118%) in crude trauma deaths occurred in 54-year-olds. Overall, in 2010, trauma was the leading cause of death in individuals 46 years and younger. Trauma remains the leading cause of years of life lost.Trauma is now the leading cause of death for individuals 46 years and younger. The largest increase in the number of trauma deaths and the highest crude number of trauma deaths occurred in baby boomers. Policy makers allocating resources should be made aware of the larger impact of trauma on our aging and burgeoning US population. Language: en

Increasing trauma deaths in the United States.

BACKGROUND: In contrast to the established principles of ‘‘damage-control orthopedics’’ for temporary external fixation of long bone or pelvic fractures, the ‘‘ideal’’ timing and modality of fixation of unstable spine fractures in severely injured patients remains controversial. METHODS: A prospective cohort study was designed to evaluate the safety and efficacy of a standardized ‘‘spine damage-control’’ (SDC) protocol for the acute management of unstable thoracic and lumbar spine fractures in severely injured patients. A total of 112 consecutive patients with unstable thoracic or lumbar spine fractures and Injury Severity Score (ISS) of greater than 15 were prospectively enrolled in this study from October 1, 2008, to December 31, 2011. Acute posterior spinal fixation within 24 hours was performed in 42 patients (SDC group), and 70 patients underwent definitive operative spine fixation in a delayed fashion (‘‘delayed surgery’’[DS] group). Both cohorts were prospectively analyzed for baseline demographics, length of operative time, amount of intraoperative blood loss, total hospital length of stay, number of ventilator-dependent days, and incidence of early postoperative complications. RESULTS: The mean time to initial spine fixation was significantly decreased in the SDC group (8.9 [1.7] hours vs. 98.7 [22.4] hours, p G 0.01). The SDC cohort had a reduced mean length of operative time (2.4 [0.7] hours vs. 3.9 [1.3] hours), length of hospital stay (14.1 [2.9] days vs. 32.6 [7.8] days), and number of ventilator-dependent days (2.2 [1.5] days vs. 9.1 [2.4] days), compared with the DS group (p G 0.05). Furthermore, the complication rate was decreased in the SDC group with regard to wound complications (2.4% vs. 7.1%), urinary tract infections (4.8% vs. 21.4%), pulmonary complications (14.3% vs. 25.7%), and pressure sores (2.4% vs. 8.6%), compared with the DS cohort (p G 0.05). CONCLUSION: A standardized SDC protocol represents a safe and efficient treatment strategy for severely injured patients with associated unstable thoracic or lumbar fractures. (J Trauma Acute Care Surg. 2013;74: 590Y596. Copyright* 2013 by Lippincott Williams & Wilkins) LEVEL OF EVIDENCE: Therapeutic study, level III.

The impact of a standardized ''spine damage-control'' protocol for unstable thoracic and lumbar spine fractures in severely injured patients: A prospective cohort study

Background. Tumor patients and patients after traumas are endangered by a reduced immune defense, and a silver coating on their megaprostheses may reduce their risks of infection. The aim of this study was to determine the silver ion concentration directly measured from the periprosthetic tissue and the influence on the clinical outcome. Material and Methods. Silver ions were evaluated in 5 mL wound fluids two days postoperatively and in blood patients 7 and 14 days after surgery using inductively coupled plasma emission spectrometry in 18 patients who underwent total joint replacement with a silver-coated megaendoprosthesis. Results. The concentration of silver ions averaged 0.08 parts per million. Patients who showed an increased silver concentration in the blood postoperatively presented a lower silver concentration in the wound fluids and a delayed decrease in C-reactive protein levels. There were significantly fewer reinfections and shorter hospitalization in comparison with a group that did not receive a silver-coated megaprosthesis. Conclusion. An increased concentration of silver in the immediate surroundings of silver-coated prostheses was demonstrated for the first time in cohorts of patients with trauma or tumors. An elevated concentration of silver ions in the direct periprosthetic tissue may have reduced the infection rate.

/pdf/measurement-of-the-silver-ion-concentration-in-wound-fluids-17j3xv52gk.pdf

Measurement of the Silver Ion Concentration in Wound Fluids after Implantation of Silver-Coated Megaprostheses: Correlation with the Clinical Outcome

The objective of the study was to gather information about elderly major trauma patients admitted to one particular Slovenian trauma centre in Celje and examine this group of polytrauma patients, specifically with respect to mechanisms of injury, injury severity and distribution of injuries. Further on, to identify morbidity and mortality rates and compare these to the younger population and, finally, to determine the factors that have the most impact on treatment results. The study gathered and evaluated data of 532 patients included in the Trauma Register DGU® of the German Trauma Society (TR-DGU) during a 10-year period and two distinct groups of patients were established, separated on account of age as older or younger than 65 years. The differences between these two groups were analyzed with respect to demographics, comorbidities, preclinical management, injury patterns, relevant clinical and laboratory findings. Furthermore, differences between deceased and surviving elderly patients were also analyzed. The majority of elderly patients suffered from a blunt mechanism of trauma (96.6%) and of these simple falls represented 47.9% within this injury mechanism. There were two body regions, which were most frequently represented, namely head and thorax injuries, accounting for 54.7% each. Complications were more frequent among the elderly, with sepsis being present in 29.9% and multiple organ failure (MOF) in 19.7% of cases. Cardiovascular failure was also high in both the elderly and young, accounting for 45.3% of the elderly and 31.3% of the younger population. The in-hospital mortality rate for the elderly group was 25.6% and was significantly higher compared to the younger counterparts (14.7%). Low fall mechanism of injury, coma and the new injury severity score (NISS) were statistically important factors for the mortality of seriously injured elderly patients during the acute phase of treatment. Despite advances in care, morbidity and mortality in elderly patients after major trauma remains considerably higher than in younger populations with head injuries accounting for the majority of fatalities. The elderly patient population in this study mostly suffered from blunt mechanisms of injury, with simple falls representing a high proportion of injury mechanisms. Generally, the injury severity scale (ISS) in the elderly is not statistically higher than with the younger population. Likewise, the distribution of injuries according to body regions is also similar; however, the elderly are more prone to complications (e. g. sepsis and MOF), which is likely due to a lower physiological reserves.

Evaluation of major trauma in elderly patients - a single trauma center analysis.

BACKGROUND: Patients are at risk for respiratory complications after sustaining blunt chest trauma, yet contradictory evidence exists about the utility of prophylactic respiratory therapy to reduce respiratory complications in this population. This study assessed the effectiveness of a proactive respiratory protocol on an in-patient ward to identify trauma patients at risk for pulmonary complications, administer appropriate therapies, and prevent deterioration requiring transfer to the ICU. METHODS: Trauma patients received a respiratory therapy evaluation at the time of admission to a general in-patient ward at a Level 1 trauma center. If subjects met protocol inclusion criteria, they received prophylactic respiratory treatments, primarily MetaNeb therapy, Vest therapy, or EzPAP. Multiple phases were included to evaluate the effectiveness of the protocol, with 50 subjects in each phase: a pre-protocol phase before adoption of the protocol; phase 1, which was found to have low physician adherence and overly broad inclusion criteria; and phase 2, with improved adherence and narrower inclusion criteria. Study inclusion criteria mirror the protocol criteria from phase 2: ≥3 rib fractures; pulmonary contusion; exacerbation of COPD, asthma, or other lung disease; or age ≥65 y with expected immobility of ≥48 h. RESULTS: The respiratory protocol was associated with an elimination of unplanned admissions to the ICU. After controlling for injury severity and other important clinical factors, receiving the protocol significantly decreased hospital stay by approximately 1.5 d. More subjects were admitted from the emergency department directly to the ward, avoiding the ICU. Bronchodilator use also decreased, although the result did not reach statistical significance. CONCLUSIONS: Study results suggest that a preventive respiratory protocol had a beneficial effect on patient outcomes; receiving the protocol reduced hospital days and eliminated unplanned admission to the ICU.

http://rc.rcjournal.com/content/respcare/61/12/1580.full.pdf

A Preventative Respiratory Protocol to Identify Trauma Subjects at Risk for Respiratory Compromise on a General In-Patient Ward.

A 57-year-old man with a history of 20/20 vision in both eyes was struck in his right eye by a plastic pellet projected by a slingshot. On arrival to the clinic room, he complained of blurred vision and photophobia for 50 days after the trauma. Visual acuity in the left eye was 20/20, but visual acuity in the right eye was 20/100, which could be corrected to 20/50. The intraocular pressure was 17.2 mm Hg in the right eye and 15.7 mm Hg in the left eye. Slit lamp examination of the right eye revealed a locally opacified lens and an anterior chamber that was deeper inferiority than superiority (Fig. 1). When the patient moved that eye, iridodonesis was also found, but the edge of the lens was not visible even after dilating the pupil (Fig. 1). The Pentacam image showed a tilted lens, which confirmed subluxation of the lens (Fig. 2). The patient’s condition was discussed, and surgical intervention was decided. After local anesthesia, the clear cornea incision was made. The anterior chamber was injected with viscoelastic material, and the complete circular capsulorrhexis was successfully made. The soft nucleus of the lens was carefully rotated into the anterior chamber and was removed. The remaining cortex and the vitreous escaped into the anterior chamber was cut by the vitreous cutter through the corneal incision. Three-fifths of the zonule was found dehisced, and no intraocular lens was implanted. Lens subluxation is a common complication of blunt ocular trauma. If the dislocation is partial, there may be no symptoms and difficult to find under routine slit lamp examination. The Pentacam is a recently introduced rotating Scheimpflug system that takes up to 50 slit images of the anterior segment in 2 seconds. It has the advantages of noncontact, short-checking time, and ready acceptance by patients. The assessment of lens thickness and densitometry, corneal transparency, thickness and curvature, anterior chamber depth, and the detection of intraocular lens tilting have already been established. This report highlights the use of Scheimpflug imaging in visualizing a traumatic lens subluxation.

Pentacam-aided diagnosis of traumatic lens subluxation.

To explore the molecular genetic cause of a four-generation autosomal dominant congenital cataract family in China. Targeted region sequencing was performed to screen for the potential mutation, and Sanger sequencing was used to confirm the mutation. The homology model was constructed to identify the protein structural change, PolyPhen-2 and Provean were used to predict the mutation impact. Functional and cellular analysis of the wild and mutant GJA8 were performed in DF-1 cells by western blotting, dye uptake assay, immunofluorescence, Annexin V-FITC staining. A novel heterozygous mutation (c.205G > A; p.Ala69Thr) was identified within GJA8, which cosegregated with congenital cataract phenotype in this family. Bioinformatics analysis showed the mutation was located in a highly conserved region, and the mutation was predicted to be pathogenic. Function analysis indicated that the mutation inhibited GJA8 hemichannel activity, reduced cell tolerance to oxidative stress, changed the protein distribution pattern and inhibited the cell growth. We have identified a novel missense mutation in GJA8 (c.205G > A, p.Ala69Thr) in a four-generation Chinese family and our results will further broaden the gene mutation spectrum of GJA8.

/pdf/identification-and-functional-analysis-of-a-novel-missense-3w994d7por.pdf

Identification and functional analysis of a novel missense mutation in GJA8, p.Ala69Thr.

Pseudoexfoliation syndrome, which represents the most commonly identified specific cause of open-angle glaucoma, is a kind of clinically systemic disease. Why there are so much exfoliative material deposited in the anterior chamber? Where did exfoliative material come from? The pathogenesis is never be confirmed exactly, though there are so many theories described by investigators. In recent years, in order to survey and evaluate the changes of the materials of the aqueous humor of patients with the Pseudoexfoliation syndrome, many investigators had done more works. This review will give a summarization of these findings.

The changes of bioactive substances in the aqueous humor of Pseudoexfoliation syndrome

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Papers

Pentacam-aided diagnosis of traumatic lens subluxation.

Identification and functional analysis of a novel missense mutation in GJA8, p.Ala69Thr.

The changes of bioactive substances in the aqueous humor of Pseudoexfoliation syndrome