Experimental Trauma Models: An Update

Treatment of polytrauma patients remains a medical as well as socioeconomic challenge. Although diagnostics and therapy improved during the last decades, multiple injuries are still the major cause of fatalities in patients below 45 years of age. Organ dysfunction and organ failure are major complications in patients with major injuries and contribute to mortality during the clinical course. Profound understanding of the systemic pathophysiological response is crucial for innovative therapeutic approaches. Therefore, experimental studies in various animal models are necessary. This review is aimed at providing detailed information of common trauma models in small as well as in large animals

Search for young stars among ROSAT All-Sky Survey X-ray sources in and around the R CrA dark cloud

We present the ROSAT All-Sky Survey data in a 126 deg^2 area in and around the CrA star forming region. With low-resolution spectroscopy of unidentified ROSAT sources we could find 19 new pre-main sequence stars, two of which are classical T Tauri stars, the others being weak-lined. The spectral types of these new T Tauri stars range from F7 to M6. The two new classical T Tauri stars are located towards two small cloud-lets outside of the main CrA cloud. They appear to be ~10 Myrs old, by comparing their location in the H-R diagram with isochrones for an assumed distance of 130 pc, the distance of the main CrA dark cloud. The new off-cloud weak-line T Tauri stars may have formed in similar cloud-lets, which have dispersed recently. High-resolution spectra of our new T Tauri stars show that they have significantly more lithium absorption than zero-age main-sequence stars of the same spectral type, so that they are indeed young. From those spectra we also obtained rotational and radial velocities. For some stars we found the proper motion in published catalogs. The direction and velocity of the 3D space motion - south relative to the galatic plane - of the CrA T Tauri stars is consistent with the dark cloud being formed originally by a high-velocity cloud impact onto the galactic plane, which triggered the star formation in CrA. We also present VRIJHK photometry for most of the new T Tauri stars to derive their luminosities, ages, and masses.Comment: A&A Suppl. in pres

Election Verifiability: Cryptographic Definitions and an Analysis of Helios, Helios-C, and JCJ

Election verifiability is defined in the computational model of cryptography. The definition formalizes notions of voters verifying their own votes, auditors verifying the tally of votes, and auditors verifying that only eligible voters vote. The Helios (Adida et al., 2009), Helios-C (Cortier et al., 2014) and JCJ (Juels et al., 2010) election schemes are analyzed using the definition. Neither Helios nor Helios-C satisfy the definition because they do not ensure that recorded ballots are tallied in certain cases when the adversary posts malicious material on the bulletin board. A variant of Helios is proposed and shown to satisfy the definition. JCJ similarly does not ensure that recorded ballots are tallied in certain cases. Moreover, JCJ does not ensure that only eligible voters vote, due to a trust assumption it makes. A variant of JCJ is proposed and shown to satisfy a weakened definition that incorporates the trust assumption. Previous definitions of verifiability (Juels et al., 2010; Cortier et al., 2014; Kiayias et al., 2015) and definitions of global verifiability (Kuesters et al., 2010; Cortier et al., 2016) are shown to permit election schemes vulnerable to attacks, whereas the new definition prohibits those schemes. And a relationship between the new definition and a variant of global verifiability is shown

Traumatic extremity arterial injury in children: Epidemiology, diagnostics, treatment and prognostic value of Mangled Extremity Severity Score

<p>Abstract</p> <p>Background</p> <p>Traumatic paediatric arterial injuries are a great challenge due to low incidence and specific characteristics of paediatric anatomy and physiology. The aim of the present study was to investigate their epidemiology, diagnostic and therapeutic options and complications. Furthermore, the prognostic value of the Mangled Extremity Severity Score (MESS) was evaluated.</p> <p>Methods</p> <p>In a retrospective clinical study 44 children aged 9.0 ± 3.2 years treated for traumatic extremity arterial lesions in our Level I trauma center between 1971 and 2006 were enrolled. Exclusion criteria were age > 14, venous and iatrogenic vascular injury. Demographic data, mechanism of injury, severity of arterial lesions (by Vollmar and MESS), diagnostic and therapeutic management, complications and outcome were evaluated.</p> <p>Results</p> <p>The most commonly injured vessel was the femoral artery (25%) followed by the brachial artery (22.7%). The mechanism of injury was penetrating (31.8%), isolated severe blunt extremity trauma (29.6%), multiple trauma (25%) and humeral supracondylar fractures (13.6%). In 63.6% no specific vascular diagnostic procedure was performed in favour of emergency surgery. Surgical reconstructive strategies were preferred (68.2%). A MESS < 7 was associated with initial (p < 0.05) and definite limb salvage (p < 0.001) of the lower extremity.</p> <p>Conclusions</p> <p>Traumatic paediatric vascular injuries are very rare. The most common situations of vascular lesions in childhood were penetrating injuries and fractures of the extremities either as isolated injuries or in multiply injured patients. In paediatric patients, the MESS could serve as a basis for decision making for limb salvage or amputation.</p

IL-6 predicts organ dysfunction and mortality in patients with multiple injuries

<p>Abstract</p> <p>Background</p> <p>Although therapeutic concepts of patients with major trauma have improved during recent years, organ dysfunction still remains a frequent complication during clinical course in intensive care units. It has previously been shown that cytokines are upregulated under stress conditions such as trauma or sepsis. However, it is still debatable if cytokines are adequate parameters to describe the current state of trauma patients. To elucidate the relevance of cytokines, we investigated if cytokines predict development of multiple organ dysfunction syndrome (MODS) or outcome.</p> <p>Methods</p> <p>A total of 143 patients with an injury severity score ≥ 16, between 16 and 65 years, admitted to the Hannover Medical School Level 1 Trauma Center between January 1997 and December 2001 were prospectively included in this study. Marshall Score for MODS was calculated for at least 14 days and plasma levels of TNF-α, IL-1β, IL-6, IL-8 and IL-10 were measured. To determine the association between cytokine levels and development of MODS the Spearman rank correlation coefficient was calculated and logistic regression and analysis were performed.</p> <p>Results and Discussion</p> <p>Patients with MODS had increased plasma levels of IL-6, IL-8 and IL-10. IL-6 predicted development of MODS with an overall accuracy of 84.7% (specificity: 98.3%, sensitivity: 16.7%). The threshold value for development of MODS was 761.7 pg/ml and 2176.0 pg/ml for mortality during the in patient time.</p> <p>Conclusion</p> <p>We conclude that plasma IL-6 levels predict mortality and that they are a useful tool to identify patients who are at risk for development of MODS.</p

Risk of symptomatic heterotopic ossification following plate osteosynthesis in multiple trauma patients: an analysis in a level-1 trauma centre

<p>Abstract</p> <p>Background</p> <p>Symptomatic heterotopic ossification (HO) in multiple trauma patients may lead to follow up surgery, furthermore the long-term outcome can be restricted. Knowledge of the effect of surgical treatment on formation of symptomatic heterotopic ossification in polytrauma is sparse. Therefore, we test the effects of surgical treatment (plate osteosynthesis or intramedullary nailing) on the formation of heterotopic ossification in the multiple trauma patient.</p> <p>Methods</p> <p>We retrospectively analysed prospectively documented data of blunt multiple trauma patients with long bone fractures which were treated at our level-1 trauma centre between 1997 and 2005. Patients were distributed to 2 groups: Patients treated by intramedullary nails (group IMN) or plate osteosynthesis (group PLATE) were compared. The expression and extension of symptomatic heterotopic ossifications on 3-6 months follow-up x-rays in antero-posterior (ap) and lateral views were classified radiologically and the maximum expansion was measured in millimeter (mm). Additionally, ventilation time, prophylactic medication like indomethacine and incidence and correlation of head injuries were analysed.</p> <p>Results</p> <p>101 patients were included in our study, 79 men and 22 women. The fractures were treated by intramedullary nails (group IMN n = 50) or plate osteosynthesis (group PLATE n = 51). Significantly higher radiologic ossification classes were detected in group PLATE (2.9 ± 1.3) as compared to IMN (2.2 ± 1.1; p = 0.013). HO size in mm ap and lateral showed a tendency towards larger HOs in the PLATE group. Additionally PLATE group showed a higher rate of articular fractures (63% vs. 28% in IMN) while IMN demonstrated a higher rate of diaphyseal fractures (72% vs. 37% in PLATE; p = 0.003). Ventilation time, indomethacine and incidence of head injuries showed no significant difference between groups.</p> <p>Conclusion</p> <p>Fracture care with plate osteosynthesis in polytrauma patients is associated with larger formations of symptomatic heterotopic ossifications (HO) while intramedullary nailing was associated with a higher rate of remote HO. For future fracture care of multiply injured patients these facts may be considered by the responsible surgeon.</p

Blunt cerebrovascular trauma causing vertebral arteryd issection in combination with a laryngeal fracture: a case report

<p>Abstract</p> <p>Introduction</p> <p>The diagnosis and therapy of blunt cerebrovascular injuries has become a focus since improved imaging technology allows adequate description of the injury. Although it represents a rare injury the long-term complications can be fatal but mostly prevented by adequate treatment.</p> <p>Case presentation</p> <p>A 33-year-old Caucasian man fell down a 7-meter scarp after losing control of his quad bike in a remote area. Since endotracheal intubation was unsuccessfully attempted due to the severe cervical swelling as well as oral bleeding an emergency tracheotomy was performed on scene. He was hemodynamically unstable despite fluid resuscitation and intravenous therapy with vasopressors and was transported by a helicopter to our trauma center. He had a stable fracture of the arch of the seventh cervical vertebra and fractures of the transverse processes of C5-C7 with involvement of the lateral wall of the transverse foramen. An abort of the left vertebral artery signal at the first thoracic vertebrae with massive hemorrhage as well as a laryngeal fracture was also detected. Further imaging showed retrograde filling of the left vertebral artery at C5 distal of the described abort. After stabilization and reconfirmation of intracranial perfusion during the clinical course weaning was started. At the time of discharge, he was aware and was able to move all extremities.</p> <p>Conclusion</p> <p>We report a rare case of a patient with vertebral artery dissection in combination with a laryngeal fracture after blunt trauma. Thorough diagnostic and frequent reassessments are recommended. Most patients can be managed with conservative treatment.</p