Traumatic brain injury (TBI) causes a profound inflammatory response within the central nervous system and peripheral immune system, which contributes to secondary brain injury and further morbidity and mortality. Preclinical investigations have demonstrated that treatments that downregulate microglia activation and polarize them toward a reparative/anti‐inflammatory phenotype have improved outcomes in preclinical models. However, no therapy to date has translated into proven benefits in human patients. Regulatory T cells (Treg) have been shown to downregulate pathologic immune responses of the innate and adaptive immune system across a variety of pathologies. Furthermore, cellular therapy has been shown to augment host Treg responses in preclinical models; yet, studies investigating the use of Treg as a therapeutic for TBI are lacking. In a rodent TBI model, we demonstrate that human umbilical cord blood Treg modulate the central and peripheral immune response after injury in vitro and in vivo.

Background- The use of the Resuscitative Endovascular Balloon Occlusion (REBOA) device is expanding in adult trauma. Reports of its use in pediatric patients have been published but no guidelines are established nor has it been FDA approved in pediatric use. Methods- 289 CT scans were reviewed to determine the average aortic diameter at the xyphoid process and umbilicus for each Broselow category. These measurements were the basis of 3D printed aortas using TangoPlus FullCure 930®. These aortas were inserted into a circulatory system model featuring two tracks to simulate thoracic and cerebral perfusion. Sonographic flow meters and pressure monitors were placed throughout and flow and pressure readings were recorded as a REBOA device was inflated in the printed aorta segment. Results- Distal aortic flow and pressure decreased while the cerebral branch demonstrated an inverse increase in flow and pressure with REBOA inflation. An initial delay between inflation and flow occlusion was noted with the initial 50% of volume inflated causing a 10% reduction in flow. The REBOA balloon inflation volumes (cc) for each Broselow Category for zone 1 and 3 are as follows: Black 7.5 & 5.5, Green 6 & 3.5, Orange 5.5 & 3, Blue 5 & 2, White 3 & 1.5 Conclusions- Pediatric patients present with a range of vessel sizes that occlude with a range of REBOA balloon inflation volumes. This study provides a basis to establish initial inflation volumes for REBOA deployment in appropriate pediatric trauma patients.

No abstract

No abstract