Browsing by Subject "Wounds and injuries"
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Item Changes in the Inflammatory Response to Injury and Its Resolution during the Loss of Regenerative Capacity in Developing Xenopus Limbs(Public Library of Science, 2013-11-20) Mescher, Anthony L.; Neff, Anton W.; King, Michael W.; Medicine, School of MedicineTissue and organ regeneration, unlike development, involves an injury that in postembryonic animals triggers inflammation followed by resolution. How inflammation affects epimorphic regeneration is largely uninvestigated. Here we examine inflammation and its resolution in Xenopus laevis hindlimb regeneration, which declines during larval development. During the first 5 days postamputation, both regeneration-competent stage 53 and regeneration-deficient stage 57 hindlimbs showed very rapid accumulation of leukocytes and cells expressing interleukin-1β and matrix metalloproteinase 9. Expression of genes for factors mediating inflammatory resolution appeared more persistent at stages 55 and 57 than at stage 53, suggesting changes in this process during development. FoxP3, a marker for regulatory T cells, was upregulated by amputation in limbs at all three stages but only persisted at stage 57, when it was also detected before amputation. Expression of genes for cellular reprogramming, such as SALL4, was upregulated in limbs at all 3 stages, but markers of limb patterning, such as Shh, were expressed later and less actively after amputation in regeneration-deficient limbs. Topical application of specific proinflammatory agents to freshly amputated limbs increased interleukin-1β expression locally. With aqueous solutions of the proinflammatory metal beryllium sulfate, this effect persisted through 7 days postamputation and was accompanied by inhibition of regeneration. In BeSO4-treated limbs expression of markers for both inflammation and resolution, including FoxP3, was prolonged, while genes for cellular reprogramming were relatively unaffected and those for limb patterning failed to be expressed normally. These data imply that in Xenopus hindlimbs postamputation inflammation and its resolution change during development, with little effect on cellular dedifferentiation or reprogramming, but potentially interfering with the expression of genes required for blastema patterning. The results suggest that developmental changes in the larval anuran immune system may be involved in the ontogenetic loss of epimorphic regeneration in this system.Item Development and validation of the DHIS2 platform for integrating sociomedical data to study wound care outcomes(Public Library of Science, 2024-12-04) Paddo, Atika Rahman; Kodela, Snigdha; Timsina, Lava; Mathew-Steiner, Shomita S.; Purkayastha, Saptarshi; Sen, Chandan K.; Surgery, School of MedicineWound trajectory and outcomes research has applications in different aspects of wound healing: forecasting wound healing time, access and utilization of wound care services, factors associated with disparities in wound care services, and its quality and outcomes. Wound care research benefits from a well-maintained record management system. In this article, we demonstrate the customization of the District Health Information Software (DHIS2) platform to integrate wound care clinical data with social determinants of health from several Comprehensive Wound Centers (CWC) in Indiana. We describe the modules and features of our platform, such as tracker capture, visualization, and maps. DHIS2 is used in more than 60 countries to monitor and evaluate health programs. However, to the best of our knowledge, this is the first attempt to use DHIS2 as a wound care data warehouse, a platform to perform wound care research for academic researchers and clinical practitioners. Clinicians can use the platform as one of the key tools to make an informed decision in determining the treatment for favorable healing trajectory and wound outcomes. We conducted a usability and acceptance survey among researchers at the Indiana Center for Regenerative Medicine and Engineering and found that DHIS2 can be a suitable infrastructure to manage metadata to import and analyze combined data from disparate sources, including Electronic Medical Records, WoundExpert, and clinical trials management software like REDCap.Item Divergence of military and civilian trauma research priorities(BMJ, 2021-06-15) Baer, David; Donaldson, Ross; McKinley, Todd; Guldberg, Robert; Orthopaedic Surgery, School of MedicineItem Endovascular treatment of penetrating nail gun injury of the cervical spine and vertebral artery: a case report(The Korean Society of Traumatology, 2022) Christodoulides, Alexei; Mitchell, Scott; Bohnstedt, Bradley N.; Neurological Surgery, School of MedicineIn this report, we present a case of high cervical penetrating trauma with vertebral artery injury and outline preprocedural, procedural, and postprocedural considerations with recommendations for the treatment of similar injuries. Management involves multiple imaging modalities, including X-ray imaging, computed tomography, computed tomography angiography, magnetic resonance imaging, and catheter angiography. We recommend endovascular treatment of these injuries when possible, based on the improved ability to achieve proximal and distal control and manage hemorrhage risk.Item Large-magnitude Pelvic and Retroperitoneal Tissue Damage Predicts Organ Failure(Springer, 2016-06) Gaski, Greg; Frantz, Travis; Steenburg, Scott; Bell, Teresa; McKinley, Todd; Department of Orthopaedic Surgery, School of MedicineBACKGROUND: Pelvic and retroperitoneal trauma is a major cause of morbidity and mortality in multiply injured patients. The Injury Severity Score (ISS) has been criticized for underrepresenting and inaccurately defining mechanical injury. The influence of pelvic injury volume on organ dysfunction and multiple organ failure (MOF) has not been described. Through the use of CT, this investigation sought to precisely define volumes of mechanical tissue damage by anatomic region and examine its impact on organ failure. QUESTIONS/PURPOSES: (1) Do patients with MOF have a greater volume of pelvic and retroperitoneal tissue damage when compared with those without MOF? (2) In patients who sustained pelvic trauma, does the magnitude of pelvic injury differ in patients with MOF? (3) Does the magnitude of organ dysfunction correlate with pelvic tissue damage volume? METHODS: Seventy-four multiply injured patients aged 18 to 65 years with an ISS ≥ 18 admitted to the intensive care unit for a minimum of 6 days with complete admission CT scans were analyzed. Each identifiable injury in the head/neck, chest, abdomen, and pelvis underwent volumetric determination using CT to generate regional tissue damage volume scores. Primary outcomes were the development of MOF as measured by the Denver MOF score and the degree of organ dysfunction by utilization of the Sequential Organ Failure Assessment (SOFA) score. Mean pelvic and retroperitoneal tissue damage volumes were compared in patients who developed MOF and those who did not develop MOF using Student's t-test. Among patients who sustained pelvic injuries, we compared mean volume of tissue damaged in patients who developed MOF and those who did not. We assessed whether there was a correlation between organ dysfunction, as measured by the SOFA score as a continuous variable, and the volume of pelvic and retroperitoneal tissue damage using the Pearson product-moment correlation coefficient. RESULTS: The average volume of tissue damage was greater in patients with MOF when compared with those without (MOF: 685.667 ± 1081.344; non-MOF: 195.511 ± 381.436; mean difference 490.156 cc [95% confidence interval {CI}, 50.076-930.237 cc], p = 0.030). Among patients who sustained pelvic injuries, those with MOF had higher average tissue damage volumes than those without MOF (MOF: 1322.000 ± 1197.050; non-MOF: 382.750 ± 465.005; mean difference 939.250 [95% CI, 229.267-1649.233], p = 0.013). Organ dysfunction (SOFA score) correlated with higher volumes of pelvic tissue damage (r = 0.570, p < 0.001). CONCLUSIONS: This investigation demonstrated that greater degrees of pelvic and retroperitoneal tissue damage calculated from injury CT scans in multiply injured patients is associated with more severe organ dysfunction and an increased risk of developing MOF. Early identification of polytrauma patients at risk of MOF allows clinicians to implement appropriate resuscitative strategies early in the disease course. Improved stratification of injury severity and a patient's anticipated clinical course may aid in the planning and execution of staged orthopaedic interventions. Future avenues of study should incorporate the ischemic/hypoperfusion component of pelvic injury in conjunction with the mechanical component presented here for improved stratification of multiply injured patients at higher risk of MOF. LEVEL OF EVIDENCE: Level III, prognostic study.Item Staged endovascular repair of an abdominal aortic aneurysm adjacent to a chronic high-flow iliocaval traumatic arteriovenous fistula(Elsevier, 2017-12-18) Wang, S. Keisin; Gutwein, Ashley R.; Casciani, Tom; Murphy, Michael P.; Lemmon, Gary W.; Surgery, School of MedicineLarge-vessel chronic traumatic arteriovenous fistulas are a rare complication after trauma. Delayed presentation can consist of one or more features of high-output cardiac failure, pulsatile abdominal mass, bruit, limb ischemia, and venous congestion. We describe a patient with a complex iliocaval fistula secondary to a remote gunshot wound associated with a large 8.5-cm aortic aneurysm. Informed consent of the patient was obtained for publication of the case.