A 36-year old man suffered an isolated head injury with a fracture of the skull, epidural and subdural hematomas as well as brain contusion (Abbreviated Injury Scale (AIS): 5 points). The hematomas ...were evacuated by craniotomy. Because of high intracranial pressure (ICP) a barbiturate coma was necessary. Additionally, the patient demonstrated acute lung injury (ARDS) due to pneumonia 8 days after trauma. The patient recovered slowly and was transferred to neurorehabilitation on day 57 after injury. During the following 12 months the patient developed a significant deficit of hip motion (extension/flexion: right: 0 degree/10 degrees/20 degrees, left: 0 degree/10 degrees/30 degrees; external/internal rotation: right and left: < 5 degrees/0 degree/< 5 degrees; abduction/adduction: right: 10 degrees/0 degree/25 degrees, left: 10 degrees/0 degree/10 degrees). X-rays and CT-scanning revealed severe heterotopic ossification (HO) of both hips with ancylosis (Brooker type IV). Resection of HO was carried out in a two stage procedure using Smith-Petersen approach. The prophylaxis for recurrence of HO included preoperative single-dose radiation (8 Gy) and postoperative treatment with indomethacin (150 mg per day). The patient revealed 15 (left hip) and 12 (right hip) months after surgery the following range of hip movement: extension/flexion: right: 5 degrees/0 degree/90 degrees, left: 5 degrees/0 degree/100 degrees; external/internal rotation: right: 20 degrees/0 degree/30 degrees, left: 20 degrees/0 degree/20 degrees; abduction/adduction: right: 30 degrees/0 degree/40 degrees, left: 30 degrees/0 degree/40 degrees. No recurrence of HO was observed in x-ray. The patient is able to work in his profession as farmer.
The formation of bars in disk galaxies is a tracer of the dynamical maturity of the population. Previous studies have found that the incidence of bars in disks decreases from the local Universe to z ...~ 1, and by z > 1 simulations predict that bar features in dynamically mature disks should be extremely rare. Here we report the discovery of strong barred structures in massive disk galaxies at z ~ 1.5 in deep rest-frame optical images from CANDELS. From within a sample of 876 disk galaxies identified by visual classification in Galaxy Zoo, we identify 123 barred galaxies. Selecting a sub-sample within the same region of the evolving galaxy luminosity function (brighter than L*), we find that the bar fraction across the redshift range 0.5< z < 2 (f_bar = 10.7 +6.3 -3.5% after correcting for incompleteness) does not significantly evolve. We discuss the implications of this discovery in the context of existing simulations and our current understanding of the way disk galaxies have evolved over the last 11 billion years.
A 24-year-old healthy man developed Clostridium perfringens myonecrosis with severe sepsis after plating of a closed femoral fracture. The leg could be preserved by complete resection of the fascia ...from all muscle compartments of the leg, including the pelvitrochanteric and the iliopsoas muscles, radical removal of necrotic muscle tissue, dissection of the para-aortal infrarenal lymphatics, daily débridements over 2 weeks, and systemic antibiotic therapy. The plate was removed because of a second septic episode followed by temporary stabilization with external fixation. After soft-tissue healing, plate fixation was carried out. The patient developed significant deficit of knee flexion (0 degree/0/20 degrees) due to heterotopic ossification of the quadriceps femoris muscle that could be improved by partial resection of heterotopic bone formation. In the same operation the bony defect of the femur was filled with autologous bone graft. The fracture healed 10 months after the accident. The patient can work full time in his previous profession as a mechanic, but again needs operative mobilization of the knee joint, including open arthrolysis and quadriceps plasty.
To study the responsiveness of peripheral blood mononuclear cells to lipopolysaccharide (LPS) after severe trauma and its regulatory mechanisms.
The release of proinflammatory reacting cytokines ...(tumor necrosis factor-alpha, interleukin (IL)-1 beta, IL-6, IL-8, interferon (IFN)-gamma) into whole blood from 12 patients on day 1, 5, 10, and 14 after severe trauma (Injury Severity Score, 39.3 +/- 2.8 points) and 10 healthy volunteers was studied after stimulation with LPS, concanavalin A, phorbol myristate acetate (PMA), and the addition of recombinant IFN-gamma.
Trauma caused a significant reduction of LPS and concanavalin A induced release of inflammation activating cytokines into whole blood, including IFN-gamma. However, the diminished release of proinflammatory cytokines could be increased with recombinant IFN-gamma or even attenuated after stimulation of peripheral blood mononuclear cells with the protein kinase C activator PMA.
Trauma leads to reduced responsiveness of blood monocytes to LPS and a decreased secretion of proinflammatory reacting lymphokines. Because activation of the protein kinase C pathway with PMA or the addition of IFN-gamma significantly increased cytokine response, endotoxin tolerance is not caused by inhibition of protein synthesis, but to disturbances in the signal transduction pathway and its regulating mediators.
Tissue injury from mechanical trauma often leads to secondary organ failure. Local accumulation of neutrophils and excessive release of toxic metabolites through inhibition of neutrophil apoptosis ...may be responsible for capillary leakage and irreversible damage of resident cells of injured tissues.
The purpose of this study was to examine the presence of apoptosis-inhibiting factors at the local site of tissue injury. Cerebrospinal fluid (CSF) from patients with severe head injury (n = 10; Abbreviated Injury Scale score, 4.5 +/- 0.2 points) and bronchoalveolar lavage fluid (BALF) from patients with serious chest trauma (n = 10; Abbreviated Injury Scale score, 4.1 +/- 0.1 points) were collected on days 1 and 3 after injury and compared with CSF (n = 5) and BALF (n = 16) obtained from patients undergoing elective orthopedic surgery. Neutrophils from healthy humans were incubated with 10% of CSF or BALF for 16 hours. Neutrophil apoptosis was determined by flow cytometric analysis of propidium iodide nuclear staining, terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling, and May-Grunwald-Giemsa staining. Levels of granulocyte colony-stimulating factor (G-CSF) in CSF and BALF were measured with enzyme-linked immunosorbent assay.
CSF and BALF from injured patients significantly inhibited spontaneous neutrophil apoptosis of healthy humans compared with control samples, whereas respiratory burst activity was enhanced (p < 0.05). Moreover, CSF and BALF from injured patients contained increased (p < 0.05) amounts of G-CSF. Neutralization of G-CSF in CSF and BALF from injured patients using monoclonal anti-G-CSF antibody markedly (p < 0.05) reduced the apoptosis-inhibiting effect of those body fluids and decreased the respiratory burst.
In patients with severe head or chest injury, G-CSF acts locally as a strong inhibitor of spontaneous neutrophil apoptosis, which may cause an increased destructive potential of neutrophils present in injured tissues.
To determine whether interleukin (IL)-10, besides its potent anti-inflammatory properties, causes depression of splenocyte functions in a murine model of gram-negative endotoxemia.
Mice (strain ...C3H/HeN) were injected intravenously with 1 mg of Escherichia coli lipopolysaccharide at 15 minutes after intravenous injection of either 200 U of recombinant murine IL-10 or saline solution. Serum levels of tumor necrosis factor alpha, IL-6, and IL-1 alpha were determined at 90 minutes and 12 hours after lipopolysaccharide challenge. In addition, splenocyte proliferation and lymphokine release (IL-2, IL-6, and interferon gamma) were measured.
Pretreatment with IL-10 markedly reduced (P < .05) serum levels of tumor necrosis factor alpha (-79%), IL-6 (-94%), and IL-1 alpha (-69%), but it significantly inhibited splenocyte proliferation (-32%) and IL-2 (-40%), IL-6 (-49%), and interferon gamma (-54%) release of splenocytes.
Interleukin-10 prevents E coli lipopolysaccharide-induced cytokinemia but dampens antigen-driven cellular immune responses. Although IL-10 protects against the detrimental effects of proinflammatory cytokines by deactivation of macrophages, its immunosuppressive effect may augment susceptibility to repeated or continuous invasion of microorganisms, as it is observed during clinical sepsis.
