J Trauma
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Trauma modulates polymorphonuclear neutrophil (PMN) function, predisposing to organ failure and infection. Many chemoattractants released by injury activate PMNs via G-protein-coupled (GPC) receptors, which elevate PMN cytosolic calcium ([Ca2+]i). Nonetheless, PMN GPC receptor function after injury is unstudied. ⋯ Receptor responses to individual GPC agonists are suppressed early after trauma, but increase by day 3. Normal chemokine priming of PMN calcium mobilization is reversed by injury; priming by PAF is intact. PMN GPC responses depend on the sequence in which agonists are encountered. Injury appears to alter these interactions, thus priming some aspects of PMN function while simultaneously suppressing others.
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Unstable pelvic ring disruptions are often associated with significant morbidity and mortality, especially in patients with multiple injuries. Early pelvic fixation provides stability and should diminish ongoing hemorrhage. A simple anterior single-pin pelvic external fixator can be applied rapidly and accurately to stabilize pelvic ring injuries as a part of the initial patient resuscitation of such patients. Simple anterior pelvic external fixation (SAPEF) frames can be used as either temporary, definitive, or supplementary fixation depending on the pelvic injury pattern. ⋯ Simple anterior pelvic external fixation can be applied rapidly using fluoroscopic guidance to direct accurate pin insertion and closed manipulative reduction of the pelvis. Depending on the specific pelvic ring injury pattern and clinical scenario, SAPEF can serve as a resuscitative temporary fixation device, as definitive pelvic treatment, or as a supplement for pelvic internal fixation implants.
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Factors influencing the progression of physical impairment to patient-perceived disability are not well known. We sought to better understand this relationship in the setting of injury. ⋯ The degree of physical impairment accounts for only a small amount of the variance in disability from lower extremity fracture. Identifiable patient characteristics including age, socioeconomic status, preinjury health, and social support together with impairment account for over half of the variance in long-term disability. Further research is needed to increase understanding of other factors that influence the progression of impairment to disability, especially those factors that may be amenable to intervention.
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Overall prognosis of nonpenetrating traumatic brain hemorrhage may be predicted by neurologic function days after insult. The relationship between immediate function and outcome has not been examined for infratentorial traumatic brain hemmorhage (iTBH) identified on computed tomographic (CT) scan. Given the severity of brain stem injury, it is conceivable that immediate function may be predictive. ⋯ We conclude that initial GCS score may be predictive of long-term outcome in patients with CT scan evidence of iTBH-a relationship to be explored further for prognostic information.
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Population-based incidence rates of work-related burn injuries and associated risk factors specific to anatomic sites and degree of burn are not known. ⋯ Specific occupations are associated with degree of burn, anatomic site, and exposures. This information will be useful for targeted intervention among high-risk occupations and work groups.