Adipose tissue: a neglected organ in the response to severe trauma?

Despite the manifold recent efforts to improve patient outcomes, trauma still is a clinical and socioeconomical issue of major relevance especially in younger people. The systemic immune reaction after severe injury is characterized by a strong pro- and anti-inflammatory response. Besides its functions as energy storage depot and organ-protective cushion, adipose tissue regulates vital processes via its secretion products. However, there is little awareness of the important role of adipose tissue in regulating the posttraumatic inflammatory response. In this review, we delineate the local and systemic role of adipose tissue in trauma and outline different aspects of adipose tissue as an immunologically active modifier of inflammation and as an immune target of injured remote organs after severe trauma

Outcome after Elective Percutaneous Coronary Intervention Depends on Age in Patients with Stable Coronary Artery Disease - An Analysis of Relative Survival in a Multicenter Cohort and an OCT Substudy.

Age is a strong predictor of survival in patients with coronary artery disease. In elder patients with increasing co-morbidities percutaneous coronary intervention (PCI) is associated with more complications and worse outcome. The calculation of relative survival rates adjusts for the "background" mortality in the general population by correcting for age and gender. We analyzed if elder patients after elective PCI have a worse relative survival compared to younger patient groups.A total of 8,342 patients who underwent elective PCI at two high volume centers between 1998 and 2009 were analyzed.The survival of our patients after PCI (observed survival) was slightly lower compared to the general population (expected survival) resulting in a slightly decreasing relative survival curve. In a multivariate Cox regression model age amongst others was a strong predictor of survival. Stratifying patients according to their age the relative survival curves of younger patients (Quartile 1: 73 years; 2,307 patients) were similar. The relative survival of mid-aged patients (Quartile 2: 58-65 years; 1,899 patients) was better than that of all other patient groups. The profile of cardiovascular risk factors differs between the various groups resulting in different composition and burden of coronary plaques in an optical coherence tomography sub-study.Patients after elective PCI have a slightly worse long-term survival compared to the age- and sex-matched general population. This is also true for different groups of age except for mid-aged patients between 58 and 63 years. Elder patients between 66 and 73 years and above 73 years have a similar relative survival compared to younger patients below 58 years, and might therefore have similar benefit from elective PCI

Medical therapy.

<p>Medical therapy.</p

OCT—examples of plaque.

<p><b>A</b>. fibrous plaque. <b>B</b>. lipid plaque. <b>C</b>. calcified plaque.</p

Angiographic characteristics.

<p>Angiographic characteristics.</p

Averaged lipid arc and lipid index.

<p>Averaged lipid arc and lipid index stratified according to age into four quartiles.</p

Observed survival according to age quartiles.

<p>Observed survival of patients stratified according to age into four quartiles.</p

OCT analysis.

<p>OCT analysis.</p

Multivariate results.

<p>Multivariate results.</p

Observed, expected and relative survival of all study-patients.

<p>The observed survival of all study-patients, the expected survival of the sex- and age-matched general population, and the resulting relative survival of all study-patients.</p