The potential role of T-cells and their interaction with antigen-presenting cells in mediating immunosuppression following trauma-hemorrhage

Objective: Trauma-hemorrhage results in depressed immune responses of antigen-presenting cells (APCs) and T-cells. Recent studies suggest a key role of depressed T-cell derived interferon (IFN)-g in this complex immune cell interaction. The aim of this study was to elucidate further the underlying mechanisms responsible for dysfunctional T-cells and their interaction with APCs following trauma-hemorrhage. Design: Adult C3H/HeN male mice were subjected to trauma-hemorrhage (3-cm midline laparotomy) followed by hemorrhage (blood pressure of 35�5mmHg for 90 min and resuscitation) or sham operation. At 24 h thereafter, spleens were harvested and T-cells (by Microbeads) and APCs (via adherence) were Isolated. Co-cultures of T-cells and APCs were established for 48 h and stimulated with concanavalin A and lipopolysaccharide. T-Cell specific cytokines known to affect APC function (i.e. interleukin(IL)-2, IL-4 and granulocyte-macrophage colony-stimulating factor (GM-CSF)) were measured in culture supernatants by Multiplex assay. The expression of MHC class II as well as co-stimulatory surface molecules on T-cells and APCs was determined by flow cytometry. Results: The release of IL-4 and GM-CSF by T-cells was suppressed following trauma-hemorrhage, irrespective of whether sham or trauma-hemorrhage APCs were present. Antigen-presenting cells from animals subjected to trauma-hemorrhage did not affect T-cell derived cytokine release by sham T-cells. In contrast, T-cells from traumahemorrhage animals depressed MHC class II expression of CD11c(þ) cells, irrespective of whether APCs underwent sham or trauma-hemorrhage procedure. Surprisingly, co-stimulatory molecules on APCs (CD80, CD86) were not affected by trauma-hemorrhage. Conclusions: These results suggest that beside IFN-g other T-cell derived cytokines contribute to immunosuppression following trauma-hemorrhage causing diminished MHC II expression on APCs. Thus, T-cells appear to play an important role in this interaction at the time-point examined. Therapeutic approaches should aim at maintenance of T-cell function and their interaction with APCs to prevent extended immunosuppression following trauma-hemorrhage

Screening For Trauma In the Foster Care Community

Children within the foster care community experience health disparities on a variety of levels, from physical and mental health conditions, developmental delay, and impaired social interactions. Many of these conditions can stem from the experience of trauma or adverse childhood events that color each component of their lives. For healthcare providers to be successful in the assessment and treatment of this community, an understanding of traumatic events and the delivery of trauma-informed care is essential. The complex needs of this community are such that the provision of healthcare must be specialized, multidimensional, and organized. The purpose of this project is to assist in the development of a clinic that specializes in the delivery of primary care to the foster care community, with a focus on screening and assessment for the experience of trauma. Children were screened for child trauma as well as for resiliency behaviors, and a tool for chart review was used to examine current health status and services. With the assistance of stakeholders, meticulous follow up on screening results, referrals and recommendations made ensured that no opportunities were missed to provide the highest quality care for this underserved community

Hearing voices, dissociation and the self: a functional-analytic perspective

Item does not contain fulltextIn the current paper, we review existing models of the aetiology of voice hearing. We summarise the argument and evidence that voice hearing is primarily a dissociative process, involving critical aspects of self. We propose a complementary perspective on these phenomena that is based on a modern behavioural account of complex behaviour, known as Relational Frame Theory (RFT). This type of approach to voice hearing concerns itself with: the functions served for the individual by this voice hearing; the necessary history, such as trauma, that establishes these functions; and the relevant dissociative processes involving self and others. In short, we propose a trauma-dissociation developmental trajectory in which trauma impacts negatively on the development of self, through the process of dissociation. Using the RFT concept of relations of perspective-taking, our dissociation model purports that trauma gives rise to more co-ordination than distinction relations between self and others, thus weaking an individual's sense of a distinct self. Voice hearing experiences, therefore, reflect an individual's perceptions of self and others, and may indicate impairments in the natural psychological boundaries between these critical related concepts. One clinical implication suggested by this model is that therapeutic 'intervention' should understand the behaviours associated with a sense of self that is fragile and threatened by others. Relations with self and others should be a key focus of therapy, as well as interventions designed to enhance a coherent distinct sense of self.20 p

History of the Innovation of Damage Control for Management of Trauma Patients: 1902-2016

Objective: To review the history of the innovation of damage control (DC) for management of trauma patients. Background: DC is an important development in trauma care that provides a valuable case study in surgical innovation. Methods: We searched bibliographic databases (1950-2015), conference abstracts (2009-2013), Web sites, textbooks, and bibliographies for articles relating to trauma DC. The innovation of DC was then classified according to the Innovation, Development, Exploration, Assessment, and Long-term study model of surgical innovation. Results: The innovation\u27\u27 of DC originated from the use of therapeutic liver packing, a practice that had previously been abandoned after World War II because of adverse events. It then developed\u27\u27 into abbreviated laparotomy using rapid conservative operative techniques.\u27\u27 Subsequent exploration\u27\u27 resulted in the application of DC to increasingly complex abdominal injuries and thoracic, peripheral vascular, and orthopedic injuries. Increasing use of DC laparotomy was followed by growing reports of postinjury abdominal compartment syndrome and prophylactic use of the open abdomen to prevent intra-abdominal hypertension after DC laparotomy. By the year 2000, DC surgery had been widely adopted and was recommended for use in surgical journals, textbooks, and teaching courses ( assessment\u27\u27 stage of innovation). Long-term study\u27\u27 of DC is raising questions about whether the procedure should be used more selectively in the context of improving resuscitation practices. Conclusions: The history of the innovation of DC illustrates how a previously abandoned surgical technique was adapted and readopted in response to an increased understanding of trauma patient physiology and changing injury patterns and trauma resuscitation practices

The Libyan civil conflict : selected case series of orthopaedic trauma managed in Malta in 2014

Aim: The purpose of this series of cases was to analyse our management of orthopaedic trauma casualties in the Libyan civil war crisis in the European summer of 2014. We looked at both damage control orthopaedics and for case variety of war trauma at a civilian hospital. Due to our geographical proximity to Libya, Malta was the closest European tertiary referral centre. Having only one Level 1 trauma care hospital in our country, our Trauma and Orthopaedics department played a pivotal role in the management of Libyan battlefield injuries. Our aims were to assess acute outcomes and short term mortality of surgery within the perspective of a damage control orthopaedic strategy whereby aggressive wound management, early fixation using relative stability principles, antibiotic cover with adequate soft tissue cover are paramount. We also aim to describe the variety of war injuries we came across, with a goal for future improvement in regards to service providing.Methods: Prospective collection of six interesting cases with severe limb and spinal injuries sustained in Libya during the Libyan civil war between June and November 2014.Conclusions: We applied current trends in the treatment of war injuries, specifically in damage control orthopaedic strategy and converting to definitive treatment where permissible. The majority of our cases were classified as most severe (Type IIIB/C) according to the Gustilo-Anderson classification of open fractures. The injuries treated reflected the type of standard and improved weaponry available in modern warfare affecting both militants and civilians alike with increasing severity and extent of damage. Due to this fact, multidisciplinary team approach to patient centred care was utilised with an ultimate aim of swift recovery and early mobilisation. It also highlighted the difficulties and complex issues required on a hospital management level as a neighbouring country to war zone countries in transforming care of civil trauma to military trauma.peer-reviewe

Contemporary views on inflammatory pain mechanisms: TRPing over innate and microglial pathways.

Tissue injury, whether by trauma, surgical intervention, metabolic dysfunction, ischemia, or infection, evokes a complex cellular response (inflammation) that is associated with painful hyperalgesic states. Although in the acute stages it is necessary for protective reflexes and wound healing, inflammation may persist well beyond the need for tissue repair or survival. Prolonged inflammation may well represent the greatest challenge mammalian organisms face, as it can lead to chronic painful conditions, organ dysfunction, morbidity, and death. The complexity of the inflammatory response reflects not only the inciting event (infection, trauma, surgery, cancer, or autoimmune) but also the involvement of heterogeneous cell types including neuronal (primary afferents, sensory ganglion, and spinal cord), non-neuronal (endothelial, keratinocytes, epithelial, and fibroblasts), and immune cells. In this commentary, we will examine 1.) the expression and regulation of two members of the transient receptor potential family in primary afferent nociceptors and their activation/regulation by products of inflammation, 2.) the role of innate immune pathways that drive inflammation, and 3.) the central nervous system's response to injury with a focus on the activation of spinal microglia driving painful hyperalgesic states

Emotion regulation and PTSI

Treball Final de Grau en Psicologia. Codi: PS1048. Curs: 2018/2019.In this review, our aim was to study the relationship between emotion regulation and PTSD. For this, the scientific literature was analyzed from the Scopus, PubMed and Web of Science databases. Broadly speaking, a total of 100 related studies were obtained, however, after an exhaustive selective process, 35 studies remained. After the review, a large number of studies were obtained confirming the close relationship between the difficulties of emotional regulation and the severity of PTSD symptoms, which is more complex than it appeared. At the same time, it was seen how emotional regulation mediates the relationship between PTSD and problems such as risky sexual behavior, alcohol consumption, trauma-cocaine association, eating disorders, depressive symptoms and problems of social adjustment after trauma. Also the relationship with alexithymia, negative affect, positive affect, more cognitive aspects (such as metacognition or the own perception of emotional intelligence), the type of trauma, dissociative symptoms and traumatic history. The influence of emotional regulation on the symptoms of PTSD is evidenced even by alterations in certain psychophysiological parameters. Another remarkable result of this review was the relationship between emotion regulation and the most severe form of PTSD, that is complex PTSD. In some way, this review is validating the importance of the difficulties of emotional regulation in PTSD and with it, the need to include sections to work these difficulties in treatment programs and even their prevention in the school setting.En esta revisión, nuestro objetivo fue estudiar la relación que hay entre la regulación emocional y el TEPT. Para ello, la literatura científica fue analizada desde las bases de datos Scopus, PubMed y Web of Science. A grandes rasgos, se obtuvieron un total de 100 estudios relacionados, sin embargo, tras un exhaustivo proceso selectivo, se quedaron en 35 estudios. Tras la revisión, se obtuvieron gran cantidad de estudios que confirmaban la estrecha relación entre las dificultades de regulación emocional y la severidad de los síntomas TEPT, siendo esta más compleja de lo que parecía. Al mismo tiempo, se vio cómo la regulación emocional media la relación entre el TEPT y problemáticas tales como conductas sexuales de riesgo, consumo de alcohol, asociación traumacocaína, trastornos alimentarios, síntomas depresivos y problemas de ajuste social tras el trauma. También la relación con la alexitimia, el afecto negativo, el afecto positivo, aspectos más cognitivos (como la metacognición o la propia percepción de la inteligencia emocional), el tipo de trauma, síntomas disociativos y la historia traumática. La influencia de la regulación emocional en los síntomas del TEPT se evidencia incluso mediante alteraciones en ciertos parámetros psicofisiológicos. Otro resultado destacable de esta revisión fue la relación entre las dificultades de regulación emocional y la forma más severa del TEPT, que es el TEPT complejo. De alguna manera, esta revisión está validando la importancia de las dificultades de regulación emocional en el TEPT y con ello, la necesidad de que se incluyan apartados para trabajar estas dificultades en los programas de tratamiento e incluso su prevención en el entorno escolar