Browsing by Subject "Trauma"
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Item Measurement of Traumatic Brain Injury (TBI) Inpatient Activity Levels Through Accelerometry(2017-05-01) Ramsey, Jeffrey T.; Patricia A. Gwirtz; J. Cameron Millar; Stephen O. MathewPurpose: The purpose of this study was to use retrospective analysis of actigraphy data to describe activity levels for patients undergoing inpatient rehabilitation. This study also examined the differences between activity levels of the different areas of therapy. The final aim of this study was to examine the affect of demographic factors, and injury characteristics on activity levels. Method: Fifty individuals with Traumatic Brain Injury (TBI) undergoing inpatient rehabilitation wore accelerometers. Activity Counts (ACs) were summarized in one-minute intervals. ACs, demographic and outcome variables were analyzed using descriptive statistics and general linear regression analysis. Results: During active therapy patients averaged 241.3 +/- 97.8 AC, which decreased to 142.2 +/- 74.1 during non-active therapy. Recreational time had an average of 112.8 +/- 59.5 AC, and sleep time had an average of 26.7 +/- 14.8 AC. Using predetermined definitions of physical activity, patients were determined to be inactive during therapy and sedentary/inactive for large portions of their stay. Linear regression analysis showed that the main factor with a negative association with physical activity is age. Discussion: The findings of this study demonstrate that patients undergoing inpatient rehabilitation are largely inactive or sedentary. Although age was determined to have the largest impact on physical activity, the other demographic and outcome measures analyzed by this study along with other confounders’ impact on physical activity require further study to determine the best way to safely increase patient activity.Item Pyruvate-Enriched Ringer's Solution Protects Hindlimb and Myocardial Tissue During Hemorrhagic Shock and Hindlimb Ischemia(2011-07-22) Gurji, Hunaid Adam; Mallet, Robert T.; Olivencia-Yurvati, Albert; Raven, Peter B.Gurji, HA. Pyruvate-Enriched Ringer’s Solution Protects Hindlimb and Myocardial Tissue During Hemorrhagic Shock and Hindlimb Ischemia. Doctor of Philosophy (Integrative Physiology), July 22, 2011, 111 pp, 1 table, 23 figures, 209 references, 142 titles. Copious blood loss is the leading cause of death in military combat. Extreme exsanguination following traumatic injury causes hypotension which may culminate in hemorrhagic shock, multiple open organ failure, and death. Currently, the only available strategy to treat hemorrhage is to apply tourniquets and administer resuscitative fluids. Although necessary to limit blood loss, protracted tourniquet application imposes ischemia on distal tissues. Revascularization of the injured limb reintroduces oxygenated blood into the ischemic zone, forming toxic reactive oxygen species. These highly reactive compounds can inactivate key metabolic enzymes, hamper ATP production, and cause end organ dysfunction. Fluid resuscitation provides crucial hemodynamic support, and affords an opportunity to treat the deleterious effects of hemorrhagic shock and ischemia-reperfusion. In order to mitigate the harmful effects of hemorrhagic shock and ischemia-reperfusion of tourniqueted extremities, a fluid resuscitant should contain agents capable of suppressing the formation of reactive oxygen and nitrogen species, thus protecting cellular metabolic function; stabilizing tissue energetics; and safeguarding end organic function. Pyruvate, an endogenous energy substrate, possesses strong antioxidative properties. This study tested whether substituting pyruvate for lactate in a Ringer’s solution would be effective at mitigating reactive oxygen species formation, protect key ATP-generating and ATP-shuttling enzymes from inactivation, bolster skeletal and cardiac muscle phosphorylation potentials, and stabilize cardiac electrical function in goats subjected to hemorrhagic shock and hindlimb ischemia-reperfusion. Isoflurane-anesthetize goats were subjected to a controlled hemorrhaged to reduce the mean arterial pressure to c. 50 mmHg. After reaching this target pressure, hindlimb ischemia (HLI) was imposed for a total of 90 min by femoral artery crossclamp and tourniquet application around the hindlimb. After 30 min of hindlimb ischemia, pyruvate- (PR) or lactate- enriched (LR) Ringer’s solution was infused intravenously (10mL/min) for 90 min. Time control (TC) goats were neither hemorrhaged nor subjected to hindlimb ischemia. At the conclusion of- and 3.5 h after- fluid resuscitation, the left ventricle and the right gastrocnemius were biopsied and flash-frozen for biochemical analysis of metabolites, enzymes, and markers of oxidative stress. In addition, custom-written software was developed to analyze QT interval variability- a marker of electrical instability- from the lead II electrocardiogram. The first phase of this project tested the hypothesis that resuscitation with PR vs. LR effectively protects cardiac metabolism and preserves cardiac electrical performance during hemorrhagic shock and hindlimb ischemia. Resuscitation with PR effectively suppressed the formation of myocardial tissue 8-isoprostane vs. goats resuscitated with LR during the acute and subacute phases of the protocol. In addition, myocardial creatine kinase (CK) activity fell after LR administration vs. TC; however, PR preserved CK activity better than LR during fluid resuscitation and 4 h after hindlimb ischemia reperfusion. PR administration augmented myocardial phosphocreatine phosphorylation potential during fluid administration and 3.5 h later to values significantly higher than those in LR-resuscitated goats. Pro-arrhythmic QTc variability was markedly increased in LR vs. PR and TC during both phases of the protocol. The second phase of this project tested the hypothesis that resuscitation with PR preserves tissue energetics in the reperfused gastrocnemius during hemorrhagic shock and hindlimb ischemia. Resuscitation with PR vs. LR effectively protected the gastrocnemius from oxidative stress in both protocols, as evidenced by the suppression of 8-isoprostane formation. PR prevented CK and aconitase inactivation vs. LR during the acute phase of reperfusion, and this enzyme protection persisted at least 3.5 h after completing fluid resuscitation. Additionally, PR augmented muscle phosphocreatine phosphorylation potential vs. TC and LR during the acute phase of reperfusion, and, like CK and aconitase activities, this augmented energy state persisted 3.5 h after the end of fluid resuscitation. We conclude that 1) Pyruvate Ringer’s resuscitation during hemorrhagic shock and hindlimb ischemia provides antioxidative protection in skeletal and cardiac muscle during fluid resuscitation; 2) Pyruvate-fortified fluid resuscitation prevents inactivation of enzymes involved in production and shuttling of ATP; 3) PR augments cardiac and muscle phosphorylation potentials during fluid resuscitation; and 4) Resuscitation with PR effectively protects cardiac electrical rhythm in the face of hemorrhagic shock and hindlimb ischemia. These investigations demonstrate the powerful antioxidative protection imposed by pyruvate, its positive effects on muscle and cardiac metabolism and energy state and its role in stabilizing cardiac electrical function during hemorrhagic shock and hindlimb ischemia.Item RESULTS OF PROXIMAL FEMORAL LOCKING PLATES FOR PROXIMAL FEMORAL NON-UNIONS(2014-03) Ming, Bryan; Collinge, CoryPurpose (a): Objective: Review clinical reports from multiple centers that have used Proximal Femoral Locking Compression Plates (PFLCPs) for non-unions of the proximal femur to elicit reasons for failure in an effort to prevent similar failures in the future. Methods (b): Retrospective chart review of 21 adult patients at 3 separate regional Level I and Level II institutions who underwent open treatment of non9nionos of the proximal femur with PFLCPs. Outcomes measured was mechanical failure defined by hardware failure and secondary outcomes including patient and construct variables that may act as predictors for mechanical failure. These included time to failure, bony union, nonunion, time to union, need for additional procedures, type of additional procedures, BMI. Results (c): At 22 months follow up, 5 hardware failures occurred (24%) and 1 persistent nonunion (5%)occurred requiring hardware removal and conversion to total hip arthroplasty. There was no statistically significant association between hardware failure and patient BMI, quality of reduction, plating technique, or bone graft use. A significant difference between cases with and without failure was medial column stability; only 40% of those with hardware failure achieved medial column stability versus 94% of those without hardware failure. Conclusions (d): Proximal Femoral Locking Compression Plates have a high rate of mechanical failure with use for non-union of the proximal femur. Our experience shows a similar rate of mechanical failure compared to previously reported experiences with the use of PFLCPs in acute fractures. Medial column instability was the only significant association of failure with the use of PFLCPs in nonunion surgery.Item Review of Blunt Pancreatic Trauma and Its Outcome(2007-12-01) Sanghvi, ChiragSanghvi, Chirag. Review of Blunt Pancreatic Trauma and Its Outcome. Master of Public Health (Biostatistics), December 2007, 37 pp., 4 tables, bibliography, 42 titles. Blunt pancreatic trauma (BPT) is an uncommon injury involving 1%-2% of blunt abdominal traumas but it can be associated with a high complication rate. Various studies have shown complication rate to range from 30%-64% following blunt pancreatic injury. With Institutional Review Board (IRB) approval a retrospective chart review study was performed for last 12 years. Chart review failed to support the hospital assigned diagnosis of BPT in 3 patients, leaving 37 cases for analysis. BPT had an overall mortality rate of 22%. In the patients surviving the injury, early surgical intervention (≤12 hours) had a complication rate of 31% versus 57% for delayed surgical intervention ([greater than] 12 hours). BPT has a high mortality rate but is usually secondary to other organs involved in the injury. Delayed surgical intervention has a higher complication rate compared to early intervention.Item Structure and Function of an Interdisciplinary Research Committee at a Hospital-Based Non-Academic Institution(2011-05-01) Fisch, Nathan J.; Patricia GwirtzPurpose: Define the structure, function and activities of a trauma research committee and establish a Standard Operating Policy for a new committee. Hypothesis: By surveying existing trauma research committees, a recommended organizational strategy and membership framework can be developed for the new trauma research committee. Design: Level 1 Trauma Centers across the United States were asked how their trauma research committees are organized. The data was presented to the new committee and a model for committee operation was suggested. Results: Using the model along with input from the trauma research committee’s leadership, a Standard Operating Policy was developed. Members were asked to review the policy and agree to follow its policies and participate in trauma research.