PurposeHost response to polytrauma occasionally has unpredictable outcomes. Immune response is a major factor influencing patient's outcome. This study evaluated the interaction of two main cytokines in immune response after major trauma, specifically interleukin-6 (IL-6) and interleukin-10 (IL-10). Plasma level of these cytokines is determined by mRNA expression of these cytokines genes which may decide the outcome of polytrauma patients.MethodsThis prospective multicenter trial held at four trauma centers enrolled 54 polytrauma patients [Injury Severity Score (ISS) ≥ 16]. Plasma levels and mRNA expression of IL-6 and IL-10 were measured for 5 days after trauma. Clinical evaluation was conducted to observe whether patients endured multiple organ dysfunction syndrome (MODS) and death. MODS evaluation was performed using sequential organ failure assessment (SOFA). Trauma load which in this study is represented with ISS, plasma level, expression of cytokine genes and patient's outcome were examined with correlation test and statistical analysis.ResultsThe elevated IL-6/IL-10 ratio indicated increased activity of systemic inflammation response, especially pro-inflammation response which bears higher probability of progressing to MODS and death. The decline of IL-6/IL-10 ratio with heavy trauma load (ISS > 30) showed that compensatory anti-inflammation response syndrome (CARS) state was more dominant than systemic inflammatory response syndrome (SIRS), indicating that malfunction and failure of immune system eventually lead to MODS and deaths. The statistical significance in plasma level of cytokines was found in the outcome group which was defined as bearing a low trauma load but mortality.ConclusionThe pattern of cytokine levels in inflammation response has great impact on the outcome of polytrauma patients. Further study at the genetic level is needed to investigate inflammation process which may influence patient's outcome.

BACKGROUND: The wound healing process includes inflammation, proliferation, and remodelling phases, the main features of which are inflammation, neoangiogenesis, and epithelialization. Hyperbaric oxygen therapy (HBOT) is one modality postulated to improve wound healing. The objective of this study was to determine whether HBOT could improve selected features of burn wound healing in an experimental rabbit model. METHODS: Researchers conducted an experimental study with 36 rabbits given second-degree burns. Subjects were separated into two groups: a control group (n = 18) and an intervention group that was given HBOT at 2.4 atmospheres absolute for 6 days (n = 18). The main outcome measure was wound healing. RESULTS: Compared with the control group, the HBOT group showed more robust inflammatory cells ( P = .025) and epithelialization ( P = .024), but no significant difference in angiogenesis ( P = .442). CONCLUSIONS: The authors conclude that HBOT may improve second-degree burn healing by increasing inflammatory cell migration and re-epithelialization.

Background Multiple organ dysfunction syndrome (MODS) in patients with major trauma remains a frequent and devastating complication in emergency departments and intensive care units. Easily and accurately identifying patients at risk for MODS post-injury, especially in multi-trauma cases, is important. The aim of this study was to develop an instrument to predict the development of MODS in adult multi-trauma patients using clinical and laboratory data available in the first 24 h after trauma. Methods We prospectively enrolled adult multi-trauma patients with Injury Severity Score (ISS) ≥16, between 16 and 65 years old, admitted to four academic Level-I trauma centers for 1 year between September 2014 and 2015. Sequential organ failure assessment score was used to determine MODS during hospitalization. A risk score was created from the final regression model consisting of significant variables as MODS predictors. Result During the period of the study, 98 multi-trauma patients were included. The mean age was 35.2 years, and most were male (85.71%). The mean ISS was 23.6, mostly (76.53%) caused by blunt injury mechanism. MODS occurred in 43 patients (43.87%). The prediction risk score consists of Revised Trauma Score (<7.25) and lactate level ≥2.75 mmol/L. This study also verified several independent risk factors for post-multi-trauma MODS such as ISS >25, presence of systemic inflammatory response syndrome, shock grade 2 or more, and white blood cells >12,000. Conclusion We derived a novel simple and applicable instrument to predict MODS in adults following multi-trauma. The use of this scoring system may allow early identification of trauma patients who are at risk for MODS and result in more aggressive targeted resuscitation and damage control surgery. Trial registration ISCRTN ISRCTN16661943. 09/11/2016 retrospectively registered. Highlights

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