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Taşkın Ö, Dişel NR. From Tragedy to Resilience in a University Hospital: Characteristics of Patients in the Aftermath of the 2023 Turkey Earthquake. Disaster Med Public Health Prep 2024; 18:e59. [PMID: 38602095 DOI: 10.1017/dmp.2024.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVE This study focuses on adults affected by the February 2023 Turkey earthquakes, aiming to uncover demographic and clinical traits. METHODS A retrospective analysis of data from adult patients who sought emergency care between February 6 and February 21, 2023, following the earthquakes, was conducted. RESULTS Among 3072 patients, 1544 (50.3%) of whom were women, trauma (31.1%) was the most prevalent cause of emergency department presentations. The median age of all patients was 44 y (interquartile range [IQR] 31-61 y). Hatay province accounted for 65.2% of trauma patients as origin. Most of the patients (66.8%) presented to the emergency department by their own means, while this was opposite for trauma patients, of whom 54.5% was transferred by means of Ambulance Service. Half of the total trauma patients were rescued from the debris, and 75.9% sustained limb injuries. Crush syndrome affected 24.7%, and emergency hemodialysis was performed on 9.1%, whereas emergency surgery was performed on 22.8% of all trauma cases. Overall, 10.2% of trauma patients lacked any identification. The rate of emergency department admittions due to respiratory and cardiovascular diseases was higher at the time of the earthquake compared with the previous year (P < 0.001). CONCLUSIONS The insights gained from this study hold valuable implications for disaster response strategies, emphasizing the importance of preparedness, timely intervention, and comprehensive patient care.
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Affiliation(s)
- Ömer Taşkın
- Emergency Service, Yüreğir State Hospital, Adana, Turkey
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Disel NR, Taskin O, Daglioglu G, Tor B, Secinti S, Devecioglu GF, Emiroglu Taskin AA. Factors affecting the mortality of February earthquakes victims in Türkiye. Am J Emerg Med 2024; 77:115-120. [PMID: 38141366 DOI: 10.1016/j.ajem.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 12/25/2023] Open
Abstract
OBJECTIVE >50,000 people died in the February 2023 earthquakes in Türkiye. The aim of this study was to identify the factors affecting mortality rates of the trauma patients who were presented to the emergency department (ED) after the earthquake and provide suggestions for better preparedness strategies for future natural disasters. METHODS This retrospective, cross-sectional study encompassed data from 955 trauma patients out of 3072 patients aged 18 years and above who sought assistance in the ED. Patients were divided into two groups: the survivor group and the exitus group. Age, gender, the city where patients came from, type of presentation, injured organ systems and mechanisms of injury, laboratory findings, the diagnoses in the ED, time spent in the ED, surgical intervention, and hemodialysis sessions were analyzed. The characteristics of those who could not be identified at the presentation to the ED were subjected to additional analysis. RESULTS Out of 955 patients, 75.9% had extremity injuries, with crushing injuries (23.6%) being predominant. There were no significant differences in age or gender between the survivor and exitus groups (p = 0.776, p = 0.522), nor in the province of admission (p = 0.249). Clinical factors indicated that the exitus group were more likely to lack identification documents (29.6%), have spent longer trapped under debris, and have a higher frequency of ambulance transportation. Injuries such as chest and abdominal trauma, specific injury types, and amputation or open wounds were notably more frequent in the exitus group. Diagnoses revealed that metabolic causes were more common in exitus group (p < 0.001). While no significant difference existed in the need for emergency surgical intervention (p = 0.939), a higher frequency of emergency hemodialysis was observed among exitus group (p = 0.001). Laboratory findings indicated higher levels of various markers and lower calcium, base excess, and pH levels among those in the exitus group. CONCLUSION In the aftermath of a devastating earthquake, this study underscores the formidable challenges faced by healthcare systems during natural disasters. To prepare for future disasters, healthcare systems must enhance resilience, develop rapid identification techniques, and adopt a holistic patient care approach.
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Affiliation(s)
- Nezihat Rana Disel
- Department of Emergency Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Omer Taskin
- Emergency Service, Yuregir State Hospital, Adana, Turkey.
| | - Gulcin Daglioglu
- Department of Biochemistry, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Burcu Tor
- Department of Emergency Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Sevcan Secinti
- Department of Emergency Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Gul Filiz Devecioglu
- Department of Emergency Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey
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Karakaya D, Yılmaz AÇ, Güngör T, Kenan BU, Çelikkaya E, Çakıcı EK. Is the renal score predictive for kidney replacement therapy in pediatric patients with crush syndrome? Pediatr Nephrol 2024; 39:291-296. [PMID: 37491518 DOI: 10.1007/s00467-023-06090-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Crush syndrome (CS) is a systemic condition resulting from rhabdomyolysis caused by prolonged pressure on muscle tissue. It is estimated that CS will develop in approximately 2-5% of all injuries related to an earthquake, and acute kidney injury (AKI) will develop in approximately 1.5% of all injuries. The present study aimed to present the evaluation of pediatric patients with CS who developed AKI to determine the risk factors that can be determined beforehand for the need for dialysis and to present a new scoring developed for dialysis indication. METHODS Pediatric patients with CS and who underwent dialysis for AKI were included in the study. The study was conducted retrospectively and as single-center data. A renal scoring system that determines the indications for dialysis in patients with CS by parameters of eGFR, creatine phosphokinase (CPK), time under rubble, presence of amputation or fasciotomy, and urine volume was included. RESULTS The mean age was 11.53 ± 4.50 years, and 58.4% of the group were male. Among the 77 patients, 33 (42.8%) underwent kidney replacement therapy (KRT). Renal score, CPK level, and presence of myoglobinuria were determined to be the best markers for KRT indication in pediatric patients with CS (p < 0.01, p = 0.02, and p < 0.01, respectively). CONCLUSIONS We suggest that if a similar disaster occurs in the future, an easy and applicable renal scoring system can contribute to the prognosis by providing appropriate and early treatment for KRT. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Deniz Karakaya
- Department of Pediatric Nephrology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Aysun Çaltık Yılmaz
- Department of Pediatric Nephrology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Tülin Güngör
- Department of Pediatric Nephrology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Bahriye Uzun Kenan
- Department of Pediatric Nephrology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Evra Çelikkaya
- Department of Pediatric Nephrology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Evrim Kargın Çakıcı
- Department of Pediatric Nephrology, Ankara Etlik City Hospital, Ankara, Turkey.
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Qiao O, Wang X, Wang Y, Li N, Gong Y. Ferroptosis in acute kidney injury following crush syndrome: A novel target for treatment. J Adv Res 2023; 54:211-222. [PMID: 36702249 PMCID: PMC10703611 DOI: 10.1016/j.jare.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Crush syndrome (CS) is a kind of traumatic and ischemic injury that seriously threatens life after prolonged compression. It is characterized by systemic inflammatory reaction, myoglobinuria, hyperkalemia and acute kidney injury (AKI). Especially AKI, it is the leading cause of death from CS. There are various cell death forms in AKI, among which ferroptosis is a typical form of cell death. However, the role of ferroptosis has not been fully revealed in CS-AKI. AIM OF REVIEW This review aimed to summarize the evidence of ferroptosis in CS-AKI and its related molecular mechanism, discuss the therapeutic significance of ferroptosis in CS-AKI, and open up new ideas for the treatment of CS-AKI. KEY SCIENTIFIC CONCEPTS OF REVIEW One of the main pathological manifestations of CS-AKI is renal tubular epithelial cell dysfunction and cell death, which has been attributed to massive deposition of myoglobin. Large amounts of myoglobin released from damaged muscle deposited in the renal tubules, impeding the normal renal tubules function and directly damaging the tubules with oxidative stress and elevated iron levels. Lipid peroxidation damage and iron overload are the distinguishing features of ferroptosis. Moreover, high levels of pro-inflammatory cytokines and damage-associated molecule pattern molecules (HMGB1, double-strand DNA, and macrophage extracellular trap) in renal tissue have been shown to promote ferroptosis. However, how ferroptosis occurs in CS-AKI and whether it can be a therapeutic target remains unclear. In our current work, we systematically reviewed the occurrence and underlying mechanism of ferroptosis in CS-AKI.
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Affiliation(s)
- Ou Qiao
- Institute of Disaster and Emergency Medicine, Medical College, Tianjin University, No. 92 Weijin Road, Nankai District, Tianjin 300072, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China
| | - Xinyue Wang
- Institute of Disaster and Emergency Medicine, Medical College, Tianjin University, No. 92 Weijin Road, Nankai District, Tianjin 300072, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China
| | - Yuru Wang
- Institute of Disaster and Emergency Medicine, Medical College, Tianjin University, No. 92 Weijin Road, Nankai District, Tianjin 300072, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China
| | - Ning Li
- Institute of Disaster and Emergency Medicine, Medical College, Tianjin University, No. 92 Weijin Road, Nankai District, Tianjin 300072, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China.
| | - Yanhua Gong
- Institute of Disaster and Emergency Medicine, Medical College, Tianjin University, No. 92 Weijin Road, Nankai District, Tianjin 300072, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China.
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Dirim AB, Sezer GE, Uzun E, Yilmaz M. Temporary hypothyroidism in severe crush syndrome: a potential novel entity. Hormones (Athens) 2023; 22:603-609. [PMID: 37596376 DOI: 10.1007/s42000-023-00475-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Thyroid hormone synthesis is a complex process in the human body. Although the thyroid gland is essential for thyroid hormone synthesis, skeletal muscles also have crucial roles in thyroid hormone metabolism due to the deiodinase activities of the muscle cells. Hypothyroidism-related myopathy is a well-known entity. However, systemic effects of acute myopathies, such as rhabdomyolysis, on thyroid hormone metabolism have not to date been fully clarified. METHODS Fifty-three earthquake victims were evaluated retrospectively. We investigated the thyroid function tests (TFTs) among patients with creatine kinase (CK) levels higher than 10.000 U/L at admission. Fifteen patients had CK levels higher than 10.000 U/L and 12 of them had data of TFTs, including thyroid stimulating hormone (TSH), free T4 (FT4), and free T3 (FT3) during hospitalization. These patients were evaluated. RESULTS TSH levels were increased in all seven patients who required HD due to severe crush syndrome. Decreased FT4 levels were detected in 71.4% of them. None of the five non-HD patients had increased TSH levels or reduced FT4 levels. During follow-up, all patients survived. Renal and thyroid functions were normalized during follow-up without thyroxin replacement in patients with no prior history of hypothyroidism. Moreover, TFTs were normalized in two patients with history of hypothyroidism under thyroxine treatment without dose adjustments. CONCLUSIONS In severe forms of crush syndrome, temporary hypothyroidism might be seen. The exact mechanism underlying this entity is not well-known. Further clinical and experimental trials should be conducted to illuminate the mechanism of disrupted thyroid hormonogenesis in crush syndrome victims.
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Affiliation(s)
- Ahmet Burak Dirim
- Department of Nephrology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, Zuhuratbaba, Tevfik Sağlam Avenue, No: 11, Bakırkoy, 34147, Istanbul, Turkey.
| | - Gamze Ergun Sezer
- Department of Nephrology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, Zuhuratbaba, Tevfik Sağlam Avenue, No: 11, Bakırkoy, 34147, Istanbul, Turkey
| | - Emine Uzun
- Department of Nephrology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, Zuhuratbaba, Tevfik Sağlam Avenue, No: 11, Bakırkoy, 34147, Istanbul, Turkey
| | - Murvet Yilmaz
- Department of Nephrology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, Zuhuratbaba, Tevfik Sağlam Avenue, No: 11, Bakırkoy, 34147, Istanbul, Turkey
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Atmis B, Bayazit AK, Cagli Piskin C, Saribas E, Piskin FC, Bilen S, Ozgur Horoz O, Ekinci F, Turker I, Telefon HA, Unal I, Yilmaz HL, Narli N, Yildizdas D. Factors predicting kidney replacement therapy in pediatric earthquake victims with crush syndrome in the first week following rescue. Eur J Pediatr 2023; 182:5591-5598. [PMID: 37804325 DOI: 10.1007/s00431-023-05250-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/09/2023]
Abstract
Crush syndrome due to traumatic rhabdomyolysis is one of the most significant problems to occur following earthquakes. On February 6, 2023, millions of people in Turkey were affected by two consecutive Kahramanmaraş earthquakes. The present study reports the analysis of clinical and laboratory findings of crush syndrome in pediatric earthquake victims admitted to our hospital from our region where the earthquake had a devastating effect. Clinical and laboratory findings concerning earthquake victims with crush syndrome were analyzed within the first week to determine what factors are predictive of kidney replacement therapy (KRT). The data of patients were retrospectively collected from medical records. A total of 310 children were admitted as earthquake victims to the pediatric emergency department. Ninety-seven (31%) of these patients had crush syndrome. Fifty-three (55%) of those with crush syndrome were female. The mean age was 10.9 ± 4.7 years, and the mean time under the rubble was 30.6 ± 23.8 h. Twenty-two patients (23%) required KRT. Hemodialysis was applied to 16 (73%) of them, and hemodiafiltration was applied to the other six (27%) in the pediatric intensive care unit. Regarding creatine kinase (CK) levels, the area under the receiver operating characteristic (ROC) curve (AUC) for predicting KRT was 0.905 (95% confidence interval [CI] 0.848-0.963; p < 0.001). The optimal cut-off value was 40,000 U/L with a sensitivity of 86% and a specificity of 83%. In terms of the percentage of body area crushed, the AUC for predicting KRT was 0.907 (95% CI 0.838-0.976; p < 0.001). The optimal cut-off value was 30% with a sensitivity of 86% and a specificity of 88%. Multiple logistic regression analysis showed that each 10% increase in body area crushed (OR 4.16, 95% CI 1.58-10.93, p = 0.004) and 1 mg/dl increase in the serum phosphorus level (OR 4.19, 95% CI 1.71-10.28, p = 0.002) were significant risk factors for dialysis treatment. CONCLUSIONS Crush syndrome and kidney problems are common following disasters like earthquakes. Clinical and laboratory findings at admission can predict dialysis requirement in earthquake victims. While CK elevation, body area crushed percentage, and increased phosphorus level were predictive of dialysis treatment, time under the rubble was not. Even if the patients were under the rubble for a short time, acute kidney injury (AKI) may develop as a result of severe hypovolemia due to crush injuries, and patients may need KRT. WHAT IS KNOWN •Crush syndrome after earthquakes needs to be treated carefully in victims and can cause AKI and mortality when not treated timely and appropriately. WHAT IS NEW •CK level elevation, body area crushed percentage, and increased phosphorus level are predictive of dialysis treatment. •The time under the rubble may not be predictive of dialysis requirement.
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Affiliation(s)
- Bahriye Atmis
- Faculty of Medicine, Department of Pediatric Nephrology, Cukurova University, Adana, Turkey.
| | - Aysun K Bayazit
- Faculty of Medicine, Department of Pediatric Nephrology, Cukurova University, Adana, Turkey
| | - Cagla Cagli Piskin
- Faculty of Medicine, Department of Pediatric Nephrology, Cukurova University, Adana, Turkey
| | - Emel Saribas
- Faculty of Medicine, Department of Pediatric Nephrology, Cukurova University, Adana, Turkey
| | - Ferhat Can Piskin
- Faculty of Medicine, Department of Radiology, Cukurova University, Adana, Turkey
| | - Sevcan Bilen
- Faculty of Medicine, Department of Pediatric Emergency, Cukurova University, Adana, Turkey
| | - Ozden Ozgur Horoz
- Faculty of Medicine, Department of Pediatric Intensive Care, Cukurova University, Adana, Turkey
| | - Faruk Ekinci
- Faculty of Medicine, Department of Pediatric Intensive Care, Cukurova University, Adana, Turkey
| | - Ikbal Turker
- Faculty of Medicine, Department of Pediatric Intensive Care, Cukurova University, Adana, Turkey
| | - Hasan Ali Telefon
- Faculty of Medicine, Department of Pediatric Intensive Care, Cukurova University, Adana, Turkey
| | - Ilker Unal
- Faculty of Medicine, Department of Biostatistics, Cukurova University, Adana, Turkey
| | - Hayri Levent Yilmaz
- Faculty of Medicine, Department of Pediatric Emergency, Cukurova University, Adana, Turkey
| | - Nejat Narli
- Faculty of Medicine, Department of Neonatology, Cukurova University, Adana, Turkey
| | - Dincer Yildizdas
- Faculty of Medicine, Department of Pediatric Intensive Care, Cukurova University, Adana, Turkey
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von Loesch ET, Bačinović M, Farwick AL, Meinhardt A, Quast O. [Rhabdomyolysis of rare etiology]. Inn Med (Heidelb) 2023; 64:999-1004. [PMID: 37296329 DOI: 10.1007/s00108-023-01539-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/12/2023]
Abstract
A 40-year-old Syrian man presented to the emergency department with a 5-day history of anuria. He had previously excreted dark urine. Major rhabdomyolysis and crush kidney were found, meaning that hemodialysis was immediately initiated. A detailed patient history in the patient's mother tongue revealed indications of metabolic myopathy. The PYGM-associated glycogen storage disease type V (McArdle disease) was confirmed by next generation sequencing panel diagnostics. The most important treatment approach is to avoid rhabdomyolysis through only moderate physical exertion.
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Affiliation(s)
- E Thassilo von Loesch
- Klinik für Hämatologie, Onkologie und Nephrologie, Stammzelltransplantation, Agaplesion Diakonie Klinikum Rotenburg, Elise-Averdieck-Str. 17, 27356, Rotenburg/Wümme, Deutschland.
| | - Mustafa Bačinović
- Klinik für Hämatologie, Onkologie und Nephrologie, Stammzelltransplantation, Agaplesion Diakonie Klinikum Rotenburg, Elise-Averdieck-Str. 17, 27356, Rotenburg/Wümme, Deutschland
| | - Anna-Lena Farwick
- Klinik für Hämatologie, Onkologie und Nephrologie, Stammzelltransplantation, Agaplesion Diakonie Klinikum Rotenburg, Elise-Averdieck-Str. 17, 27356, Rotenburg/Wümme, Deutschland
| | - Achim Meinhardt
- Klinik für Hämatologie, Onkologie und Nephrologie, Stammzelltransplantation, Agaplesion Diakonie Klinikum Rotenburg, Elise-Averdieck-Str. 17, 27356, Rotenburg/Wümme, Deutschland
| | - Oliver Quast
- Neurologische Klinik, Agaplesion Diakonie Klinikum Rotenburg, Rotenburg/Wümme, Deutschland
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Conchin A, Kaux JF, Daenen B, Bruyère PJ, Radoux C, Courtois AC. [Acute deltoid compartment syndrome]. Rev Med Liege 2023; 78:535-539. [PMID: 37830316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
In this article, we present a rare type of acute compartment syndrome affecting the deltoid muscle, which occurred after a crush syndrome in a patient discovered at home in a stuporous state. Although compartment syndromes are not rare, certain circumstances cause unusual consequences and localizations, shoulder impotence in the present case. The importance of an early diagnosis is obvious to avoid the risk of irreversible lesions. We describe predisposing circumstances and provide a brief review of the pathophysiology of this syndrome.
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Affiliation(s)
- Antoine Conchin
- Service de Médecine physique et Réadaptation fonctionnelle, CHU Liège, Belgique
| | - Jean-François Kaux
- Service de Médecine physique et Réadaptation fonctionnelle, CHU Liège, Belgique
| | | | | | - Cécile Radoux
- Service de Médecine physique et Réadaptation fonctionnelle, CHR Huy, Belgique
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Usuda D, Shimozawa S, Takami H, Kako Y, Sakamoto T, Shimazaki J, Inoue J, Nakayama S, Koido Y, Oba J. Crush syndrome: a review for prehospital providers and emergency clinicians. J Transl Med 2023; 21:584. [PMID: 37653520 PMCID: PMC10472640 DOI: 10.1186/s12967-023-04416-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/04/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Disasters and accidents have occurred with increasing frequency in recent years. Primary disasters have the potential to result in mass casualty events involving crush syndrome (CS) and other serious injuries. Prehospital providers and emergency clinicians stand on the front lines of these patients' evaluation and treatment. However, the bulk of our current knowledge, derived from historical data, has remained unchanged for over ten years. In addition, no evidence-based treatment has been established to date. OBJECTIVE This narrative review aims to provide a focused overview of, and update on, CS for both prehospital providers and emergency clinicians. DISCUSSION CS is a severe systemic manifestation of trauma and ischemia involving soft tissue, principally skeletal muscle, due to prolonged crushing of tissues. Among earthquake survivors, the reported incidence of CS is 2-15%, and mortality is reported to be up to 48%. Patients with CS can develop cardiac failure, kidney dysfunction, shock, systemic inflammation, and sepsis. In addition, late presentations include life-threatening systemic effects such as hypovolemic shock, hyperkalemia, metabolic acidosis, and disseminated intravascular coagulation. Immediately beginning treatment is the single most important factor in reducing the mortality of disaster-situation CS. In order to reduce complications from CS, early, aggressive resuscitation is recommended in prehospital settings, ideally even before extrication. However, in large-scale natural disasters, it is difficult to diagnose CS, and to reach and start treatments such as continuous administration of massive amounts of fluid, diuresis, and hemodialysis, on time. This may lead to delayed diagnosis of, and high on-site mortality from, CS. To overcome these challenges, new diagnostic and therapeutic modalities in the CS animal model have recently been advanced. CONCLUSIONS Patient outcomes can be optimized by ensuring that prehospital providers and emergency clinicians maintain a comprehensive understanding of CS. The field is poised to undergo significant advances in coming years, given recent developments in what is considered possible both technologically and surgically; this only serves to further emphasize the importance of the field, and the need for ongoing research.
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Affiliation(s)
- Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-City, Tokyo, 177-8521, Japan.
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-City, Tokyo, 177-8521, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-City, Tokyo, 177-8521, Japan
| | - Yoshinobu Kako
- Department of Sport Management, Faculty of Business Informatics, Jobu University, 634-1, Toya-Chou, Isesaki-City, Gunma, 372-8588, Japan
| | - Taigo Sakamoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-City, Tokyo, 113-8602, Japan
| | - Junya Shimazaki
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, 2-15, Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Junichi Inoue
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, 1-383, Kosugi-Cho, Nakahara-Ku, Kawasaki-City, Kanagawa, 211-8533, Japan
| | - Shinichi Nakayama
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1, Wakinohamakaigandori, Chuo-Ku, Kobe-City, Hyogo, 651-0073, Japan
| | - Yuichi Koido
- National Hospital Organization Headquarters, DMAT Secretariat MHLW Japan, 3256, Midoricho, Tachikawa-City, Tokyo, 190-8579, Japan
| | - Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-City, Tokyo, 177-8521, Japan
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Karahan F, Ünal S, Tezol Ö, Sürmeli Döven S, Durak F, Alakaya M, Mısırlıoğlu M, Yeşil E, Kıllı İ, Kurt H, Altunköprü G. Thromboprophylaxis in pediatric patients with earthquake-related crush syndrome: a single centre experience. Pediatr Surg Int 2023; 39:248. [PMID: 37584864 DOI: 10.1007/s00383-023-05540-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Injuries increase the risk of venous thromboembolism (VTE). However, the literature on the management of anticoagulant therapy in pediatric patients with crush injury is limited. In this study, we aimed to share our experience about anticoagulant thromboprophylaxis in pediatric patients with earthquake-related crush syndrome. METHODS This study included patients who were evaluated for VTE risk after the Turkey-Syria earthquake in 2023. Since there is no specific pediatric guideline for the prevention of VTE in trauma patients, risk assessment for VTE and decision for thromboprophylaxis was made by adapting the guideline for the prevention of perioperative VTE in adolescent patients. RESULTS Forty-nine patients [25 males and 24 females] with earthquake-related crush syndrome had participated in the study. The median age of the patients was 13.5 (8.8-15.5) years. Seven patients (14.6%) who had no risk factors for thrombosis were considered to be at low risk and did not receive thromboprophylaxis. Thirteen patients (27.1%) with one risk factor for thrombosis were considered to be at moderate risk and 28 patients (58.3%) with two or more risk factors for thrombosis were considered to be at high risk. Moderate-risk patients (n = 8) and high-risk patients aged < 13 years (n = 11) received prophylactic enoxaparin if they could not be mobilized early, while all high-risk patients aged ≥ 13 years (n = 13) received prophylactic enoxaparin. CONCLUSION With the decision-making algorithm for thyromboprophylaxis we used, we observed a VTE rate of 2.1% in pediatric patients with earthquake-related crush syndrome.
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Affiliation(s)
- Feryal Karahan
- Faculty of Medicine, Department of Pediatric Hematology, Mersin University, Mersin, Turkey
| | - Selma Ünal
- Faculty of Medicine, Department of Pediatric Hematology, Mersin University, Mersin, Turkey
| | - Özlem Tezol
- Faculty of Medicine, Department of Pediatrics, Mersin University, Mersin, Turkey.
| | - Serra Sürmeli Döven
- Faculty of Medicine, Department of Pediatric Nephrology, Mersin University, Mersin, Turkey
| | - Fatma Durak
- Faculty of Medicine, Department of Pediatrics, Mersin University, Mersin, Turkey
| | - Mehmet Alakaya
- Faculty of Medicine, Department of Pediatric Intensive Care, Mersin University, Mersin, Turkey
| | - Merve Mısırlıoğlu
- Faculty of Medicine, Department of Pediatric Intensive Care, Mersin University, Mersin, Turkey
| | - Edanur Yeşil
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Mersin University, Mersin, Turkey
| | - İsa Kıllı
- Faculty of Medicine, Department of Pediatric Surgery, Mersin University, Mersin, Turkey
| | - Hakan Kurt
- Faculty of Medicine, Department of Pediatrics, Mersin University, Mersin, Turkey
| | - Gül Altunköprü
- Faculty of Medicine, Department of Pediatrics, Mersin University, Mersin, Turkey
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11
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Hamlah A, Tarabishy AA, Al-Madhagi H. Mini Review of Biochemical Basis, Diagnosis and Management of Crush Syndrome. Acta Med Litu 2023; 30:133-138. [PMID: 38516515 PMCID: PMC10952423 DOI: 10.15388/amed.2023.30.2.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 03/23/2024] Open
Abstract
Crush syndrome (CS) is a metabolic disorder whose victims are individuals suffered from natural disasters such as earthquake or man-made conflicts. CS complications include acute kidney injury and cardiac arrhythmia that collectively end with death if untreated immediately. These complications are accounted for the liberation of damaged muscle tissues contents, primarily myoglobin and potassium. The present mini review discusses the biochemical basis of the development of CS. In addition, diagnosis and management and the application of novel experimental therapeutics of CS are also highlighted.
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Affiliation(s)
| | | | - Haitham Al-Madhagi
- Department of Chemistry, Faculty of Science, Aleppo University, Syria Biochemical Technology Program, Dhamar University, Yemen
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12
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Kundakci B, Mirioglu A, Tekin M, Bagir M, Bicer OS, Arslan YK, Ozkan C, Ozbarlas HS. 6 February 2023, orthopedic experience in Kahramanmaraş earthquake and surgical decision in patients with crush syndrome. J Orthop Surg Res 2023; 18:537. [PMID: 37501149 PMCID: PMC10375751 DOI: 10.1186/s13018-023-04001-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The decision of fasciotomy or amputation in crush syndrome is controversial and challenging for surgeons. We aimed to share our experiences after the Kahramanmaraş earthquake, to predict the severity of crush syndrome and mortality, and to guide the surgical decision. METHODS The clinical data of patients during their first week of hospitalization were analyzed retrospectively. Totally, 233 crush syndrome patients were included. Demographic data, physical and laboratory findings, surgical treatments, and outcomes were recorded. RESULTS The mean time under the rubble was 41.89 ± 29.75 h. Fasciotomy and amputation were performed in 41 (17.6%) and 72 (30.9%) patients. One hundred and two patients (56.7%) underwent hemodialysis. Fifteen patients (6.4%) died. Lower extremity injury, abdominal trauma, and thoracic trauma were associated with mortality. Mortality was significantly increased in patients with thigh injuries (p = 0.028). The mean peak CK concentration was 69.817.69 ± 134.812.04 U/L. Peak CK concentration increased substantially with amputation (p = 0.002), lower limb injury (p < 0.001), abdominal trauma (p = 0.011), and thoracic trauma (p = 0.048). CONCLUSIONS Thigh injury is associated with the severity of crush syndrome and mortality. Late fasciotomy should not be preferred in crush syndrome. Amputation is life-saving, especially in desperate lower extremity injuries.
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Affiliation(s)
- Bugra Kundakci
- Department of Orthopaedics and Traumatology, Cukurova University Faculty of Medicine, Adana, Turkey.
| | - Akif Mirioglu
- Department of Orthopaedics and Traumatology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Mustafa Tekin
- Department of Orthopaedics and Traumatology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Melih Bagir
- Department of Orthopaedics and Traumatology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Omer Sunkar Bicer
- Department of Orthopaedics and Traumatology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Yusuf Kemal Arslan
- Department of Biostatistics, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Cenk Ozkan
- Department of Orthopaedics and Traumatology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Hilmi Serdar Ozbarlas
- Department of Orthopaedics and Traumatology, Cukurova University Faculty of Medicine, Adana, Turkey
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13
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Okubo K, Takayama K, Kawakami H, Iida K, Miyauchi H, Roppongi Y, Ikeyama H, Hayashi M, Fujishima S, Sasaki J, Haruta J, Hayashi Y, Hirahashi J. Precision engineered peptide targeting leukocyte extracellular traps mitigate acute kidney injury in Crush syndrome. Biochem Biophys Res Commun 2023; 671:173-182. [PMID: 37302292 DOI: 10.1016/j.bbrc.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Abstract
Crush syndrome induced by skeletal muscle compression causes fatal rhabdomyolysis-induced acute kidney injury (RIAKI) that requires intensive care, including hemodialysis. However, access to crucial medical supplies is highly limited while treating earthquake victims trapped under fallen buildings, lowering their chances of survival. Developing a compact, portable, and simple treatment method for RIAKI remains an important challenge. Based on our previous finding that RIAKI depends on leukocyte extracellular traps (ETs), we aimed to develop a novel medium-molecular-weight peptide to provide clinical treatment of Crush syndrome. We conducted a structure-activity relationship study to develop a new therapeutic peptide. Using human peripheral polymorphonuclear neutrophils, we identified a 12-amino acid peptide sequence (FK-12) that strongly inhibited neutrophil extracellular trap (NET) release in vitro and further modified it by alanine scanning to construct multiple peptide analogs that were screened for their NET inhibition ability. The clinical applicability and renal-protective effects of these analogs were evaluated in vivo using the rhabdomyolysis-induced AKI mouse model. One candidate drug [M10Hse(Me)], wherein the sulfur of Met10 is substituted by oxygen, exhibited excellent renal-protective effects and completely inhibited fatality in the RIAKI mouse model. Furthermore, we observed that both therapeutic and prophylactic administration of M10Hse(Me) markedly protected the renal function during the acute and chronic phases of RIAKI. In conclusion, we developed a novel medium-molecular-weight peptide that could potentially treat patients with rhabdomyolysis and protect their renal function, thereby increasing the survival rate of victims affected by Crush syndrome.
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Affiliation(s)
- Koshu Okubo
- Center for General Medicine Education, Keio University School of Medicine, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kentaro Takayama
- Department of Medicinal Chemistry, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo, 192-0392, Japan; Department of Environmental Biochemistry, Division of Biological Sciences, Kyoto Pharmaceutical University, Yamashina, Kyoto, 607-8414, Japan
| | - Hiroshi Kawakami
- Division of Food and Nutrition, Graduate School of Human Sciences, Kyoritsu Women's University, Chiyoda-ku, Tokyo, 101-8437, Japan
| | - Kiriko Iida
- Center for General Medicine Education, Keio University School of Medicine, Shinjuku-ku, Tokyo, 160-8582, Japan; Division of Food and Nutrition, Graduate School of Human Sciences, Kyoritsu Women's University, Chiyoda-ku, Tokyo, 101-8437, Japan
| | - Hiroaki Miyauchi
- Center for General Medicine Education, Keio University School of Medicine, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoshimi Roppongi
- Department of Medicinal Chemistry, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo, 192-0392, Japan
| | - Hiroaki Ikeyama
- Department of Medicinal Chemistry, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo, 192-0392, Japan
| | - Matsuhiko Hayashi
- Center for General Medicine Education, Keio University School of Medicine, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Junichi Sasaki
- Center for General Medicine Education, Keio University School of Medicine, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Junji Haruta
- Center for General Medicine Education, Keio University School of Medicine, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoshio Hayashi
- Department of Medicinal Chemistry, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo, 192-0392, Japan
| | - Junichi Hirahashi
- Center for General Medicine Education, Keio University School of Medicine, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Long B, Liang SY, Gottlieb M. Crush injury and syndrome: A review for emergency clinicians. Am J Emerg Med 2023; 69:180-187. [PMID: 37163784 DOI: 10.1016/j.ajem.2023.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/17/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Primary disasters may result in mass casualty events with serious injuries, including crush injury and crush syndrome. OBJECTIVE This narrative review provides a focused overview of crush injury and crush syndrome for emergency clinicians. DISCUSSION Millions of people worldwide annually face natural or human-made disasters, which may lead to mass casualty events and severe medical issues including crush injury and syndrome. Crush injury is due to direct physical trauma and compression of the human body, most commonly involving the lower extremities. It may result in asphyxia, severe orthopedic injury, compartment syndrome, hypotension, and organ injury (including acute kidney injury). Crush syndrome is the systemic manifestation of severe, traumatic muscle injury. Emergency clinicians are at the forefront of the evaluation and treatment of these patients. Care at the incident scene is essential and focuses on treating life-threatening injuries, extrication, triage, fluid resuscitation, and transport. Care at the healthcare facility includes initial stabilization and trauma evaluation as well as treatment of any complication (e.g., compartment syndrome, hyperkalemia, rhabdomyolysis, acute kidney injury). CONCLUSIONS Crush injury and crush syndrome are common in natural and human-made disasters. Emergency clinicians must understand the pathophysiology, evaluation, and management of these conditions to optimize patient care.
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Affiliation(s)
- Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA.
| | - Stephen Y Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, USA.
| | - Michael Gottlieb
- Ultrasound Director, Assistant Professor, Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
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15
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Soni KD, Singh A, Tyagi A, Singh Y, Aggarwal R, Trikha A. Risk Factors and Outcomes of Post-traumatic Acute Kidney Injury Requiring Renal Replacement Therapy: A Case-Control Study. Indian J Crit Care Med 2023; 27:22-25. [PMID: 36756485 PMCID: PMC9886052 DOI: 10.5005/jp-journals-10071-24380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/18/2022] [Indexed: 01/02/2023] Open
Abstract
Background Acute kidney injury (AKI) following severe trauma is common. However, the requirement of renal replacement therapy (RRT) in these patients is rare and is associated with high morbidity and mortality. The primary objective of this study was to identify odds of risk factors, in particular, hypotension at presentation, for the requirement of RRT in patients with AKI following trauma. Methods We performed a case-control study involving patients who were admitted to the intensive care unit (ICU) at a level I trauma center for at least 24 hours. The primary outcome measure was a study of the odds of risk factors associated with the requirement of RRT in such patients. Univariate comparisons and multiple logistic regression analyses were done to identify other risk factors. Results The presence of crush injury, sepsis, and elevated serum creatinine (sCr) on arrival were identified to be independent risk factors for RRT requirement. Hypotension and exposure to radiocontrast or nephrotoxic antimicrobials were not found to be associated with the need for RRT. Acute kidney injury requiring RRT was associated with significantly increased ICU length of stay (15 days vs 5 days; p < 0.001) and higher mortality (83% vs 35%; p < 0.001). Conclusion The presence of crush injury, sepsis, and elevated sCr on presentation were identified to be independent risk factors while hypotension association was insignificant for AKI requiring RRT in our investigation. How to cite this article Soni KD, Singh A, Tyagi A, Singh Y, Aggarwal R, Trikha A. Risk Factors and Outcomes of Post-traumatic Acute Kidney Injury Requiring Renal Replacement Therapy: A Case-Control Study. Indian J Crit Care Med 2023;27(1):22-25.
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Affiliation(s)
- Kapil Dev Soni
- Department of Critical and Intensive Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Singh
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Abhay Tyagi
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Yudhyavir Singh
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Aggarwal
- Department Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India,Richa Aggarwal, Department Intensive Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India, Phone: +91 9873731042, e-mail:
| | - Anjan Trikha
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, United States of America
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16
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Phoba N, Zunza M. Incidence and factors associated with being a victim of community assault; retrospective review of medical records in an Emergency Centre. Afr J Emerg Med 2022; 12:85-88. [PMID: 35155088 DOI: 10.1016/j.afjem.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/16/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Community assault is an interpersonal violence frequently seen in the emergency centres around South Africa. Its aim is to inflict serious injuries to a suspected perpetrator. Data has not been published in Mamelodi Regional Hospital setting whereas the cases have been observed in the emergency centre (EC). The study objectives were to determine the incidence and factors associated with being a victim of community assault in the EC in a regional hospital in Pretoria and clinical outcomes. METHODS We retrospectively reviewed the medical records of adult patients who were treated for assault in the EC of Mamelodi Regional Hospital between 5 March 2017 and 5 March 2018. EC electronic registries and medical file were used to identify all patients who presented with body injuries due to assault. RESULTS Only 807 of 1070 medical records had complete data on the exposure variables of study interest. Of the 807 participants who presented with body injury due to assault, 77 (9.544% (95% CI 7.52 to 11.57)) were due to community assault. The majority of the victims were young adults, of male gender and not married. More than half of the participants were unemployed. Young adult age doubled the odds of being a victim of community assault odds ratio (OR) 2.19 (95% CI 1.02 to 4.70). The odds of being a victim of community assault for males were 11 times the odds of females OR 11.30 (95% CI 2.74 to 46.49). Of the 77 victims of community assault, 45 (58%) were admitted, 25 (32%) were discharged after receiving treatment, 6 (8%) refused treatment and 1 (1%) died. DISCUSSION We describe the incidence of, and factors associated with, community assault in the EC of Mamelodi Regional Hospital in Pretoria. Our findings suggest that a modest incidence rate of being a victim of community assault. Young adult males are mostly the target victims of community and non-community assault. Further research is needed to understanding factors precipitating community assault and to test potential community and non-community assault prevention interventions, targeting young adult males.
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Affiliation(s)
- Ndedi Phoba
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Mamelodi Regional Hospital, Pretoria, South Africa
| | - Moleen Zunza
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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17
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Wang PT, Li N, Wang XY, Chen JL, Geng CH, Liu ZQ, Fan HJ, Lv Q, Hou SK, Gong YH. RIG-I, a novel DAMPs sensor for myoglobin activates NF-κB/caspase-3 signaling in CS-AKI model. Mil Med Res 2021; 8:37. [PMID: 34148549 PMCID: PMC8215750 DOI: 10.1186/s40779-021-00333-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 06/10/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is the main life-threatening complication of crush syndrome (CS), and myoglobin is accepted as the main pathogenic factor. The pattern recognition receptor retinoicacid-inducible gene I (RIG-I) has been reported to exert anti-viral effects function in the innate immune response. However, it is not clear whether RIG-I plays a role in CS-AKI. The present research was carried out to explore the role of RIG-I in CS-AKI. METHODS Sprague-Dawley rats were randomly divided into two groups: the sham and CS groups (n = 12). After administration of anesthesia, the double hind limbs of rats in the CS group were put under a pressure of 3 kg for 16 h to mimic crush conditions. The rats in both groups were denied access to food and water. Rats were sacrificed at 12 h or 36 h after pressure was relieved. The successful establishment of the CS-AKI model was confirmed by serum biochemical analysis and renal histological examination. In addition, RNA sequencing was performed on rat kidney tissue to identify molecular pathways involved in CS-AKI. Furthermore, NRK-52E cells were treated with 200 μmol/L ferrous myoglobin to mimic CS-AKI at the cellular level. The cells and cell supernatant samples were collected at 6 h or 24 h. Small interfering RNAs (siRNA) was used to knock down RIG-I expression. The relative expression levels of molecules involved in the RIG-I pathway in rat kidney or cells samples were measured by quantitative Real-time PCR (qPCR), Western blotting analysis, and immunohistochemistry (IHC) staining. Tumor necrosis factor-α (TNF-α) was detected by ELISA. Co-Immunoprecipitation (Co-IP) assays were used to detect the interaction between RIG-I and myoglobin. RESULTS RNA sequencing of CS-AKI rat kidney tissue revealed that the different expression of RIG-I signaling pathway. qPCR, Western blotting, and IHC assays showed that RIG-I, nuclear factor kappa-B (NF-κB) P65, p-P65, and the apoptotic marker caspase-3 and cleaved caspase-3 were up-regulated in the CS group (P < 0.05). However, the levels of interferon regulatory factor 3 (IRF3), p-IRF3 and the antiviral factor interferon-beta (IFN-β) showed no significant changes between the sham and CS groups. Co-IP assays showed the interaction between RIG-I and myoglobin in the kidneys of the CS group. Depletion of RIG-I could alleviate the myoglobin induced expression of apoptosis-associated molecules via the NF-κB/caspase-3 axis. CONCLUSION RIG-I is a novel damage-associated molecular patterns (DAMPs) sensor for myoglobin and participates in the NF-κB/caspase-3 signaling pathway in CS-AKI. In the development of CS-AKI, specific intervention in the RIG-I pathway might be a potential therapeutic strategy for CS-AKI.
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Affiliation(s)
- Peng-Tao Wang
- General Hospital of Tianjin Medical University, Tianjin, 300052, China
| | - Ning Li
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, China.,State Key Laboratory of Medicinal Chemical Biology, Nankai University, Tianjin, 300350, China.,Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, 300072, China.,Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, 325000, China
| | - Xin-Yue Wang
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, China.,Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, 300072, China
| | - Jia-Le Chen
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, China.,Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, 300072, China
| | - Chen-Hao Geng
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, China.,Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, 300072, China
| | - Zi-Quan Liu
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, China.,Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, 300072, China.,Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, 325000, China
| | - Hao-Jun Fan
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, China.,Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, 300072, China.,Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, 325000, China
| | - Qi Lv
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, China.,Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, 300072, China.,Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, 325000, China
| | - Shi-Ke Hou
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, China. .,Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, 300072, China. .,Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, 325000, China.
| | - Yan-Hua Gong
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, China. .,Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, 300072, China. .,Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, 325000, China.
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18
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Abstract
Mass disasters, particularly earthquakes, cause many medical problems, including kidney problems, but an organized approach to cope with them was initiated only at the end of previous century, subsequent to the Armenian Spitak earthquake in 1988. Originally, interventions were focused on acute kidney injury (AKI) following crush injury and rhabdomyolysis in victims who had been trapped under the debris of collapsed buildings. However, similar problems were also registered in the context of other catastrophic events, especially man-made disasters like wars and torture. Other kidney-related problems, such as the preservation of treatment continuity in chronic kidney disease (CKD), especially in maintenance dialysis patients, deserved attention as well. Specific therapeutic principles apply to disaster-related kidney problems and these may differ from usual day-to-day clinical practice. Those approaches have been formulated in global and specific country-related guidelines and recommendations. It is clear that a well-conceived and organized management of kidney diseases in disasters benefits outcomes. Furthermore, it may be useful if the model and philosophy that were applied over the last three decades could be adapted by broadening the scope of disasters leading to intervention. Actions should be guided and coordinated by a panel of experts steering ad hoc interventions, rather than applying the "old" static model where a single coordinating center instructs and uses volunteers listed long before a potential event occurs.
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Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 10, Corneel Heymanslaan, B9000 Gent, Belgium.
| | - Mehmet Sükrü Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Millet Caddesi, 34093 Istanbul, Turkey
| | - Norbert Lameire
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 10, Corneel Heymanslaan, B9000 Gent, Belgium
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19
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Hareedy MS, Abdelzaher LA, Badary DM, Mohammed Alnasser S, Abd-Eldayem AM. Valproate attenuates hypertonic glycerol-induced rhabdomyolysis and acute kidney injury. Nephrol Ther 2021; 17:160-167. [PMID: 33781712 DOI: 10.1016/j.nephro.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM The current study investigated the effects of treatment with 300 mg/kg valproic acid on rhabdomyolysis and acute kidney injury induced by intramuscular injection of hypertonic glycerol in rats. METHODS Four groups of male wistar rats: control and hypertonic glycerol, valproic acid and valproic acid + hypertonic glycerol treated groups were used. Blood urea nitrogen, serum creatinine, creatinine kinase (CK) and CK MB, myoglobin and renal reduced glutathione (GSH) levels were measured. Histopathological examination of the kidneys was carried out to evaluate the degree of renal injury in each group. The expression of interleukin-1 beta "IL-1β" in renal tissue was detected using immunohistochemistry. RESULTS Hypertonic glycerol administration led to severe renal tubular damage with a significant elevation of blood urea nitrogen, serum creatinine, creatinine kinase, CK MB and myoglobin levels and overexpression of IL-1β compared to control group. Valproic acid administration attenuated both the muscle injury and the acute kidney injury induced by hypertonic glycerol, estimated through a significant reduction of creatinine kinase, myoglobin, and serum creatinine. Valproic acid administration caused a significant increase in GSH in the hypertonic glycerol + valproic acid group compared to the hypertonic glycerol group. A significant decrease in tubular necrosis grade, and expression of IL-1β in hypertonic glycerol + valproic acid group compared to the hypertonic glycerol group was observed. CONCLUSION This study demonstrates, for the first time to the best of our knowledge, that valproic acid could ameliorate the rhabdomyolysis and the related acute kidney injury in rats.
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Affiliation(s)
- Mohammad Salem Hareedy
- Department of pharmacology, Faculty of medicine, Assiut University, 71515 Assiut, Egypt.
| | - Lobna A Abdelzaher
- Department of pharmacology, Faculty of medicine, Assiut University, 71515 Assiut, Egypt
| | - Dalia M Badary
- Department of pathology, Faculty of medicine, Assiut University, 7152 Assiut, Egypt
| | - Sulaiman Mohammed Alnasser
- Department of pharmacology and toxicology, Unaizah College of pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Ahmed M Abd-Eldayem
- Department of pharmacology, Faculty of medicine, Assiut University, 71515 Assiut, Egypt
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Osuka A, Miyao D, Kuge Y, Nakajima S, Kuroki Y, Ueyama M. Good recovery without decompression fasciotomy for crush syndrome caused by using a Japanese-style toilet. Trauma Case Rep 2021; 32:100411. [PMID: 33659604 PMCID: PMC7890425 DOI: 10.1016/j.tcr.2021.100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 11/29/2022] Open
Abstract
We report a case of crush syndrome that developed while the patient was squatting to use a Japanese-style toilet. The patient was a 61-year-old male with an obese body. He was sitting on the toilet and couldn't stand up, and after a few hours, the landlord found him and called the emergency services. On presentation, the patient was hyperkalemic and in shock, and his serum creatine kinase levels rose to a maximum of 287,600 U/L. He was diagnosed with postural crush syndrome in both lower extremities due to squatting position in a Japanese-style toilet. Subjective symptoms, physical examination, and blood tests were monitored and the patient was observed. As a result, the patient could be treated conservatively without fasciotomy. Dialysis was not necessary because the fluid infusion maintained adequate urine output and corrected the hyperkalemia. Magnetic resonance imaging of both lower extremities showed multiple high-signal areas in the muscles of the bilateral thighs and lower legs. This case suggested that if the wound is closed, the peripheral pulse is palpable, and the patient's symptoms have improved, a fasciotomy should not be performed. People who are too heavy to squat may need to be careful when using this kind of toilet.
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Affiliation(s)
- Akinori Osuka
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Daiki Miyao
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Yuji Kuge
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Shinji Nakajima
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Yuichi Kuroki
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Masashi Ueyama
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
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Abstract
The main goals of treating severe crush injuries are debriding away devitalized tissue and filling any resultant dead space with vascularized tissue. In the authors' experience, the most ideal methods for soft tissue coverage in treating crush injuries are the iliac flap, the adipofascial lateral arm flap, and the gracilis flap. Accompanying bone defects respond very well to free corticoperiosteal flaps. Digital defects often require the use of complete or subtotal toe transfer to avoid amputation and restore function to the hand.
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Abstract
Following disasters, children are physically, psychologically and socially more vulnerable than adults; consequently, their morbidity and mortality are higher. The risks are especially high for orphans and unaccompanied children who are separated from their families, making them frequently victims of human trafficking, slavery, drug addiction, crime or sexual exploitation. Education of children and families about disaster-related risks and providing special protection in disaster preparedness plans may mitigate these threats. Kidney disease patients, both paediatric and adult, are extra vulnerable during disasters, because their treatment is dependent on technology and functioning infrastructure. Acute kidney injury, chronic kidney disease patients not on dialysis and dialysis and transplant patients are faced with extensive problems. Overall, similar treatment principles apply both for adults and paediatric kidney patients, but management of children is more problematic, because of substantial medical and logistic difficulties. To minimize drawbacks, it is vital to be prepared for renal disasters. Preparedness plans should address not only medical professionals, but also patients and their families. If problems cannot be coped with locally, calling for national and/or international help is mandatory. This paper describes the spectrum of disaster-related problems in children and the specific features in treating acute and chronic kidney disease in disasters.
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Affiliation(s)
- Mehmet Sukru Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Millet Caddesi, 34093, Capa Istanbul, Turkey.
| | - Lale Sever
- Department of Paediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
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Arango-Granados MC, Cruz Mendoza DF, Salcedo Cadavid AE, García Marín AF. Amputation in crush syndrome: A case report. Int J Surg Case Rep 2020; 72:346-350. [PMID: 32563818 PMCID: PMC7306514 DOI: 10.1016/j.ijscr.2020.05.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/30/2020] [Indexed: 11/24/2022] Open
Abstract
Crush syndrome (CS) produces severe electrolyte disorders, circulatory and multiple organ failure due to severe rhabdomyolysis and reperfusion injuries. To date, the main stem of management is aggressive fluid resuscitation. Fasciotomy for the treatment of compartment syndromes due to crush injuries is still controversial, and it is still unknown if early amputation has patient-centered benefits. This case suggests a potential benefit of amputation in patients with CS and progressive deterioration. It also invites to think if this is a decision to consider early in the course of the disease. The presence of risk factors for poor prognosis and the natural course of the disease can favor amputation despite the apparent viability of the limb and the morbidity of losing of an extremity.
Introduction Crush syndrome (CS) is a condition with a high morbidity and mortality due to severe electrolyte disorders, circulatory dysfunction and multiple organ failure, secondary to severe rhabdomyolysis and reperfusion injuries. There is controversy about the role of fasciotomy in the treatment of compartment syndromes due to crush injuries and it is still unknown if early amputation has patient-centered benefits. Case presentation This is a 29-year-old patient whose lower body was trapped for 50 h under a 40-meter landslide. Upon admission the left thigh was edematous and painful. Laboratories revealed a creatinine of 1.58 mg/dL, hyperkalemia, metabolic acidosis, hyperlactatemia and creatinine phosphokinase (CPK) of 88,700 U/L, suggesting CS. Despite fluid and bicarbonate infusion his renal function worsened, CPK rose and left thigh became more tense, so a fasciotomy was performed. He developed a distributive shock refractory to vasopressors, steroids and methylene blue so amputation was proposed. Two hours after amputation the vasopressor support was nearly withdrawn. Discussion This case suggests a potential benefit of amputation in patients with CS and progressive deterioration despite aggressive resuscitation. It also invites to think if this is a decision that should be considered before the establishment or in the initial stages of the syndrome, even if the viability of the extremity is still questionable. Conclusion The presence of risk factors for poor prognosis can favor amputation despite the apparent viability of the limb and the morbidity of losing an extremity.
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Affiliation(s)
- María Camila Arango-Granados
- Fundación Valle del Lili, Cra. 98 ## 18-49, Cali, Valle del Cauca, Colombia; Universidad Icesi, Cl. 18 #122-135, Facultad de Medicina, Cali, Valle del Cauca, Colombia.
| | - Diego Fernando Cruz Mendoza
- Fundación Valle del Lili, Cra. 98 ## 18-49, Cali, Valle del Cauca, Colombia; Universidad Icesi, Cl. 18 #122-135, Facultad de Medicina, Cali, Valle del Cauca, Colombia.
| | - Alexander Ernesto Salcedo Cadavid
- Fundación Valle del Lili, Cra. 98 ## 18-49, Cali, Valle del Cauca, Colombia; Universidad Icesi, Cl. 18 #122-135, Facultad de Medicina, Cali, Valle del Cauca, Colombia.
| | - Alberto Federico García Marín
- Fundación Valle del Lili, Cra. 98 ## 18-49, Cali, Valle del Cauca, Colombia; Universidad Icesi, Cl. 18 #122-135, Facultad de Medicina, Cali, Valle del Cauca, Colombia.
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Guevorkian AG. The effect of hypothalamic peptides, neurohormone C and proline-rich peptide-1on the Ca 2+-handling system in heartin pathophysiological conditions. Heliyon 2020; 6:e04360. [PMID: 32637717 PMCID: PMC7330072 DOI: 10.1016/j.heliyon.2020.e04360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/26/2020] [Accepted: 06/26/2020] [Indexed: 11/21/2022] Open
Abstract
Atthe Institute of Biochemistry named after H. Buniatyan we discovered and studied hypothalamic peptides with coronary dilatory and antioxidant activities:neurohormone C (NC) and proline-rich peptide-1 (PRP-1). Both NC and PRP-1 exhibit cardioprotective effects, in part by restoring the calcium affinity for calcium-binding membrane proteins in cardiomyocytes. This affinity is diminished in the sarcoplasmic reticulum and mitochondriawith myocardial damage, heart failure, pancreatic necrosis and crush syndrome caused by isoproterenol. The peptides can also destroy the four detected toxic peptides and myocardial depressant factor, and protect against ischemia-reperfusion injury. Further studies of these peptides may be promising for the treatment of patients at high risk of cardiovascular disease, regardless of pathology.
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Affiliation(s)
- Artashes G. Guevorkian
- Department of Biochemistry, Yerevan State Medical University after MkhitarHeratsi, 2 Koryun St., Yerevan 0025, Armenia
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Abstract
This article reports the case of a 42-year-old male patient, who sustained a gluteal compartment syndrome after drug-induced immobilization with subsequent rhabdomyolysis and sciatic nerve palsy. Unlike compartment syndrome of the forearm or lower leg, this is a rare condition. After immediate surgical decompression and installation of negative pressure wound treatment, hemofiltration in acute renal failure could be averted using forced diuresis. The sensorimotor function of the lower extremity improved already after the first treatment and secondary wound closure was possible after 1 week. The patient was discharged 11 days after admission with complete recovery of sensorimotor and renal functions.
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Affiliation(s)
- J Gleich
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, Campus Innenstadt und Großhadern, Marchioninistraße 17, 81377, München, Deutschland.
| | - J Fürmetz
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, Campus Innenstadt und Großhadern, Marchioninistraße 17, 81377, München, Deutschland
| | - C Kamla
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, München, Deutschland
| | - V Pedersen
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, Campus Innenstadt und Großhadern, Marchioninistraße 17, 81377, München, Deutschland
| | - W Böcker
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, Campus Innenstadt und Großhadern, Marchioninistraße 17, 81377, München, Deutschland
| | - A M Keppler
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, Campus Innenstadt und Großhadern, Marchioninistraße 17, 81377, München, Deutschland
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Yang XY, Song J, Hou SK, Fan HJ, Lv Q, Liu ZQ, Ding H, Zhang YZ, Liu JY, Dong WL, Wang X. Ulinastatin ameliorates acute kidney injury induced by crush syndrome inflammation by modulating Th17/Treg cells. Int Immunopharmacol 2020; 81:106265. [PMID: 32044661 DOI: 10.1016/j.intimp.2020.106265] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is the main complication of crush syndrome (CS), and it is also a cause of lethality in CS. However, effective treatments for AKI are still lacking. Ulinastatin (UTI) is a broad-spectrum serine protease inhibitor extracted from human urine that reportedly modulates innate immunity and pro-inflammatory responses in sepsis. Here, we explored the effect and the potential mechanism of ulinastatin on crush syndrome-induced acute kidney injury (CSAKI). METHODS A CSAKI rat model was established by using a digital crush injury device platform. Forty-six male Wistar rats were randomly divided into five groups: the normal control (n = 6), CSAKI model (n = 10), CSAKI plus UTI1 (50,000 U/kg) (n = 10), CSAKI plus UTI2 (100,000 U/kg) (n = 10) and CSAKI plus UTI3 (200,000 U/kg) (n = 10) groups. Hematoxylin-eosin (HE) staining was used to investigate the reliability of the CSAKI model. The percentage of Th17/Treg lymphocytes in peripheral blood was measured by flow cytometry, and the expression of transcription factors associated with Th17/Treg cells was evaluated by quantitative real-time polymerase chain reaction (PCR). In addition, specific cytokines released by Th17/Treg cells in serum and kidney tissues were detected by enzyme-linked immunosorbent assay (ELISA). RESULTS Treatment with ulinastatin could significantly decrease serum BUN, CK, Scr, Mb and K+ levels compared with CSAKI group. HE staining results showed that ulinastatin could inhibit inflammatory cells infiltration, decrease sarcomere rupture in muscle tissues induced by extrusion, and alleviate the glomerular congestion and edema, as well as decrease myoglobin cast in kidney tissues. The proportion of CD4+CD25+Foxp3+ regulatory T (Treg) cells and Foxp3 expression levels were decreased in the CSAKI animals, while IL-17 expression levels were significantly increased, compared with those of the normal control group. Treatment with ulinastatin upregulated the proportion of Treg cells in CD4+ T cells and downregulated the expression of IL-17 compared with those of the CSAKI group. CONCLUSION The findings of our study indicate that UTI attenuates CS-induced AKI and alleviate the inflammatory response during the early stage. The mechanism of UTI may be due to regulating the balance between Th17/Treg cells. Our study provides a new mechanism for the beneficial effect of ulinastatin on CSAKI.
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Affiliation(s)
| | - Jie Song
- Department of Nephrology, Characteristic Medical Center of Chinese People's Armed Police Forces, Tianjin, China
| | - Shi-Ke Hou
- Institute of Disaster Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China.
| | - Hao-Jun Fan
- Institute of Disaster Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Qi Lv
- Institute of Disaster Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China.
| | - Zi-Quan Liu
- Institute of Disaster Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Hui Ding
- Institute of Disaster Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Yong-Zhong Zhang
- Institute of Disaster Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Jin-Yang Liu
- Institute of Disaster Medicine and Public Health, Characteristic Medical Center of the Chinese People's Armed Police Force (PAP), Tianjin, China
| | - Wen-Long Dong
- Institute of Disaster Medicine, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Xue Wang
- Institute of Disaster Medicine and Public Health, Characteristic Medical Center of the Chinese People's Armed Police Force (PAP), Tianjin, China
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Omrani H, Najafi I, Bahrami K, Najafi F, Safari S. Acute kidney injury following traumatic rhabdomyolysis in Kermanshah earthquake victims; A cross-sectional study. Am J Emerg Med 2020; 40:127-132. [PMID: 32008829 DOI: 10.1016/j.ajem.2020.01.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/18/2020] [Accepted: 01/23/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Rhabdomyolysis induced acute kidney injury (AKI) develops due to leakage of the potentially nephrotoxic intracellular content into the circulation. This study aimed to evaluate the prevalence and predictive factors of AKI in Kermanshah earthquake victims. METHODS This cross-sectional study was performed on victims of 2017 Kermanshah earthquake, Iran, who were admitted in Kermanshah and Tehran Hospitals. Data of the hospitalized patients were gathered and the prevalence of rhabdomyolysis induced AKI was studied. In addition, correlations of various clinical and laboratory variables with rhabdomyolysis induced AKI were assessed. RESULTS 370 hospitalized patients with the mean age of 39.24 ± 20.32 years were studied (58.6% female). 10 (2.7% of all admitted) patients were diagnosed with AKI. Time under the rubble (p < .0001), serum level of creatinine phosphokinase (CPK) (p < .001), lactate dehydrogenase (LDH) (p < .0001), aspartate aminotransferase (AST) (p = .001) and uric acid (p = .003) were significantly higher in patients with AKI. Area under the ROC curves of CPK, LDH, AST, and uric acid for predicting the risk of developing AKI were 0.883 (95% CI: 0.816-0.950), 0.865 (95% CI: 0.758-0.972), 0.846 (95% CI: 0.758-0.935), and 0.947 (95% CI: 0.894-0.100), respectively. The best cutoff points for CPK, LDH, AST, and uric acid in this regard were 1656 IU/L, 839.5 U/L, 46.00 IU/L, and 5.95 mg/dL. CONCLUSION The rate of traumatic rhabdomyolysis induced AKI development was estimated to be 2.7%. Time under the rubble and serum levels of CPK, LDH, AST, and uric acid were identified as the most important predictive factors of AKI development.
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Affiliation(s)
- Hamidreza Omrani
- Imam Reza Hospital Research Center, Kermanshah University of Medical sciences, Kermanshah, Iran
| | - Iraj Najafi
- Nephrology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kiomars Bahrami
- Imam Reza Hospital Research Center, Kermanshah University of Medical sciences, Kermanshah, Iran
| | - Farid Najafi
- Imam Reza Hospital Research Center, Kermanshah University of Medical sciences, Kermanshah, Iran
| | - Saeed Safari
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Emergency Department, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Kadıoğlu E, Tekşen Y, Koçak C, Koçak FE. Beneficial effects of bardoxolone methyl, an Nrf2 activator, on crush-related acute kidney injury in rats. Eur J Trauma Emerg Surg 2019; 47:241-250. [PMID: 31471671 DOI: 10.1007/s00068-019-01216-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/21/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effects of bardoxolone methyl (BM), a nuclear factor erythroid 2-related factor 2 (Nrf2) activator, on acute kidney injury in a rat model of crush syndrome model. METHODS Sixty-four rats were separated equally into eight groups, sham (sterile saline ip), crush, crush + vehicle (DMSO ip), and crush + BM (10 mg/kg ip) (n = 8). All groups were also divided as 3 and 24 h after decompression. Crush injury was induced by 6 h of direct compression to both hind limbs of the rats with blocks weighing 3.6 kg on each side, followed by 3 and 24 h of decompression. Kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), tumor necrotizing factor-α (TNF-α), transforming growth factor-β1 (TGF-β1) concentrations, tissue total oxidant status (TOS) and total antioxidant status (TAS) were measured in the kidneys. Serum creatine kinase (CK), blood urea nitrogen (BUN) and creatinine concentrations were also measured. Glomerular and tubular structures were examined histopathologically. Bcl-2 was measured using immunohistochemistry. Apoptosis was assessed using the TUNEL method. RESULTS BM treatment reduced KIM-1, NGAL, TNF-α, TGF-β1, TOS concentrations, and increased TAS concentrations in the kidneys 3 and 24 h after decompression. Serum CK, BUN and creatinine concentrations were also reduced with BM. BM treatment decreased apoptosis in crush-related AKI. The Nrf2 activator BM reversed the crush-induced changes in the experimental rats. CONCLUSION BM treatment prevented the progression of crush-related AKI in rats possibly through its cytoprotective effects of being an antioxidant, anti-inflammatory and anti-apoptotic agent.
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Affiliation(s)
- Emine Kadıoğlu
- Department of Emergency Medicine, Faculty of Medicine, Kütahya Health Sciences University, Evliya Çelebi Yerleşkesi, 43000, Kutahya, Turkey
| | - Yasemin Tekşen
- Department of Pharmacology, Faculty of Medicine, Kütahya Health Sciences University, Evliya Çelebi Yerleşkesi, 43000, Kutahya, Turkey.
| | - Cengiz Koçak
- Department of Pathology, Faculty of Medicine, Uşak University, Bir Eylül Kampüsü, 64000, Uşak, Turkey
| | - Fatma Emel Koçak
- Department of Biochemistry, Faculty of Medicine, Kütahya Health Sciences University, Evliya Çelebi Yerleşkesi, 43000, Kutahya, Turkey
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Abstract
In the absence of evidence, therapies are often based on intuition, belief, common sense or gut feeling. Over the years, some treatment strategies may become dogmas that are eventually considered as state-of-the-art and not questioned any longer. This might be a reason why there are many examples of "strange" treatments in medical history that have been applied in the absence of evidence and later abandoned for good reasons.In this article, five dogmas relevant to critical care medicine are discussed and reviewed in the light of the available evidence. Dogma #1 relates to the treatment of oliguria with fluids, diuretics, and vasopressors. In this context, it should be considered that oliguria is a symptom rather than a disease. Thus, once hypovolaemia can be excluded as the underlying reason, there is no justification for giving fluids, which may do more harm than good in euvolaemic or hypervolaemic patients. Similarly, there is no solid evidence for forcing diuresis by administering vasopressors and loop diuretics. Dogma #2 addresses the treatment of crush syndrome patients with aggressive fluid therapy using NaCl 0.9%. In fact, this treatment may aggravate renal injury by iatrogenic metabolic acidosis and subsequent renal hypoperfusion. Dogma #3 concerns the administration of NaCl 0.9% to patients undergoing kidney transplantation. Since these patients are usually characterised by hyperkalaemia, the potassium-free solution NaCl 0.9%, containing exclusively 154 mmol/l of sodium and chloride ions each, is often considered as the fluid of choice. However, large volumes of chloride-rich solutions cause hyperchloraemic acidosis in a dose-dependent manner and induce a potassium shift to the extracellular space, thereby increasing serum potassium levels. Thus, balanced electrolyte solutions are to be preferred in this setting. Dogma #4 relates to the fact that enteral nutrition is often withheld for patients with high residual gastric volume due to the theoretical risk of gastro-oesophageal reflux, potentially resulting in aspiration pneumonitis. Despite controversial discussions, there is no clinical data supporting that residual gastric volume should be generally measured, especially not in patients without a gastro-intestinal surgery and/or motility disorders. Clinical evidence rather suggests that abandoning residual gastric volume monitoring does not increase the incidence of pneumonia, but may benefit patients by facilitating adequate enteral feeding. Finally, dogma #5 is about sedating all mechanically ventilated patients because "fighting" against the respirator may cause insufficient ventilation. This concern needs to be balanced against the unwanted consequences of sedation, such as prolonged mechanical ventilation and intensive care unit length of stay as well as increased risk of delirium. Modern concepts based on adequate analgesia and moderate to no sedation appear to be more suitable.In conclusion, dogmas are still common in clinical practice. Since science rather than fiction should govern our actions in intensive care medicine, it is important to remain critical and challenge long established concepts, especially when the underlying evidence is weak or non-existing.
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Affiliation(s)
- Martin Westphal
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany. .,Fresenius Kabi AG, Else-Kröner-Str. 1, 61352, Bad Homburg, Germany.
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Kobayashi J, Murata I. Nitrite as a pharmacological intervention for the successful treatment of crush syndrome. Physiol Rep 2019; 6. [PMID: 29512311 PMCID: PMC5840435 DOI: 10.14814/phy2.13633] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/16/2018] [Accepted: 02/02/2018] [Indexed: 01/01/2023] Open
Abstract
Crush syndrome is characterized by ischemia/reperfusion injury (IRI). The protective effect of nitrite on experimentally induced IRI has been demonstrated in the heart, kidney, liver, and skeletal muscle. IRI in tissues and systemic organs occurs due to the massive generation of reactive oxygen species and subsequent systemic inflammation. Therefore, ischemic pre and postconditioning are performed in clinical practice. Intravenous administration of nitrite inhibits IRI through nitric oxide-mediated mechanisms. In this paper, we discuss the utility of nitrite as a pharmacological postconditioning agent in the treatment of crush syndrome.
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Affiliation(s)
- Jun Kobayashi
- Division of Pathophysiology, Department of Clinical Dietetics and Human Nutrition, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Saitama, Japan
| | - Isamu Murata
- Division of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Saitama, Japan
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Tekşen Y, Kadıoğlu E, Koçak C, Koçak H. Effect of Hydrogen Sulfide on Kidney Injury in Rat Model of Crush Syndrome. J Surg Res 2018; 235:470-478. [PMID: 30691831 DOI: 10.1016/j.jss.2018.10.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 09/27/2018] [Accepted: 10/18/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute kidney injury is the most serious complication of crush syndrome. Hydrogen sulfide (H2S) is an endogenously produced gaseous signaling molecule. It is involved in homeostatic functions, such as blood pressure control, apoptosis, oxidative stress, and inflammation. In this study, effects of H2S on kidney injury were investigated in a rat model of crush syndrome. METHODS Rats were divided into six groups (n = 8): Sham (steril saline ip), crush (sterile saline ip), crush + NaHS (sodium hydrosulfide, an H2S donor) (100 μmol/kg ip). All these groups were also separated as 3 and 24 h after decompression. Crush injury was induced by 6 h of direct compression to both hindlimbs of anesthetized rats with blocks weighing 3.6 kg each sides, followed by 3 or 24 h of decompression. Kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, tumor-necrotizing factor-α, transforming growth factor-β, tissue total oxidant status, and total antioxidant status levels were measured in kidney homogenates 3 and 24 h after decompression. Serum creatine kinase, blood urea nitrogen, and creatinine levels were also measured. Apoptosis was assessed by TUNEL method. Bcl-2 was assessed by immunohistochemistry. Glomerular and tubular structures were also examined histopathologically. RESULTS NaHS reduced kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, tumor-necrotizing factor-α, transforming growth factor-β, total oxidant status levels, and increased total antioxidant status levels in kidney 3 and 24 h after decompression. Serum urea, creatinine, and creatine kinase levels also reduced with NaHS. NaHS decreased renal damage and apoptosis in crush-related acute kidney injury. CONCLUSIONS These results suggest that H2S could reduce crush-related acute kidney injury via anti-inflammatory, antioxidant, and antiapoptotic effects.
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Affiliation(s)
- Yasemin Tekşen
- Department of Pharmacology, Faculty of Medicine, Dumlupınar University, Kütahya, Turkey.
| | - Emine Kadıoğlu
- Department of Emergency Medicine, Faculty of Medicine, Dumlupınar University, Kütahya, Turkey
| | - Cengiz Koçak
- Department of Pathology, Faculty of Medicine, Dumlupınar University, Kütahya, Turkey
| | - Havva Koçak
- Department of Biochemistry, Faculty of Medicine, Asst. Prof. Dumlupınar University, Kütahya, Turkey
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Honore PM, De Bels D, Spapen HD. Beneficial effects of antioxidant therapy in crush syndrome in a rodent model: enough evidences to be used in humans? Ann Intensive Care 2018; 8:96. [PMID: 30264204 PMCID: PMC6160376 DOI: 10.1186/s13613-018-0431-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 08/24/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Patrick M Honore
- ICU Department, Centre Hospitalier Universitaire Brugmann, 4, Place Arthur Van Gehuchten, 1020, Brussels, Belgium.
| | - David De Bels
- ICU Department, Centre Hospitalier Universitaire Brugmann, 4, Place Arthur Van Gehuchten, 1020, Brussels, Belgium
| | - Herbert D Spapen
- Universitair Ziekenhuis Brussel, VUB University, Brussels, Belgium
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Murata I, Kawanishi R, Inoue S, Iwata M, Kobayashi J, Inoue Y, Kanamoto I. A novel method to assess the severity and prognosis in crush syndrome by assessment of skin damage in hairless rats. Eur J Trauma Emerg Surg 2018; 45:1087-1095. [PMID: 30054668 DOI: 10.1007/s00068-018-0987-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Crush syndrome (CS), a serious medical condition characterised by damage to the muscle cells due to pressure, is associated with high mortality, even when patients receive fluid therapy during transit to the hospital or admission to the hospital. There is no standard triage approach for earthquake victims with crush injuries due to the scarcity of epidemiologic and quantitative data. We examined whether mortality can be predicted based on the severity of skin damage so that assess the severity and prognosis in crush syndrome by assessment of skin damage in hairless rats because we have previously observed that CS results in oedema and redness of the skin in rats. METHODS Anaesthetised rats were subjected to bilateral hind limb compression [1 kg (mild) and 2 kg (severe) loads] with a rubber tourniquet for 5 h. The rats were then randomly divided into three groups: sham, mild CS, and severe CS. RESULTS The mild and severe CS groups had mortality rates of 20 and 90%, respectively. The severe CS group demonstrated higher rates of hyperkalaemia, hypovolemic shock, acidosis, and inflammation. Skin damage was significantly worse in the severe CS group compared to the mild CS group. Skin damage showed good correlation with pathological severity. CONCLUSIONS Skin damage is a valid measure of transepidermal water loss and severity of CS. We suggest that these models may be useful to professionals who are not experienced in disaster management to identify earthquake victims at high risk of severe CS.
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Affiliation(s)
- Isamu Murata
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan.
| | - Ryota Kawanishi
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Syo Inoue
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Moeko Iwata
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Jun Kobayashi
- Division of Pathophysiology, Department of Clinical Dietetics and Human Nutrition, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, 350-0295, Saitama, Japan
| | - Yutaka Inoue
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Ikuo Kanamoto
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
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Sgarbi MWM, Silva Júnior BA, Pires DDA, Velasco IT. Comparison of the effects of volemic reposition with 7.5% NaCl or blood in an experimental model of muscular compression and hemorrhagic shock. Rev Bras Ortop 2018; 53:614-621. [PMID: 30246000 PMCID: PMC6147761 DOI: 10.1016/j.rboe.2018.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/08/2017] [Indexed: 01/04/2023] Open
Abstract
Objective Crush syndrome is characterized by traumatic muscular injuries with severe systemic clinical repercussions. The systemic inflammatory reaction characterized acutely by infiltration of neutrophils in the lungs has been studied as part of the spectrum of crush syndrome. Experimental research may demonstrate alternative treatments for crush syndrome. The authors studied the hypothesis that hypertonic saline solution (7.5% NaCl) could minimize the local and systemic effects in a model of muscular compression and hemorrhagic shock. Methods Rabbits were submitted to a new model of muscle compression associated with hemorrhagic shock. Compression was applied through an Esmarch bandage, used for 1 h on the entire right lower limb. Hemorrhagic shock was induced for 1 h by dissection and catheterization of the carotid artery. Blood replacement or hypertonic saline solution was used to treat the shock. Biochemical analysis of plasma, quantification of muscular edema, and infiltration of inflammatory cells in the lungs were carried out. Results Animals treated with hypertonic solution presented the same hemodynamic response as the blood treated patients, less water in the compressed muscles and less infiltration of inflammatory cells in the lungs. The blood group presented hypocalcemia, a facet of crush syndrome. Conclusions The proposed model was effective for the study of crush syndrome associated with hemorrhagic shock. The treatment with hypertonic solution showed benefits when compared with blood volume replacement.
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Cui H, Xiong G, Zhang C, Xiao Z. [Diagnosis and treatment of crush syndrome of chest and arm]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018; 32:703-706. [PMID: 29905048 PMCID: PMC8414012 DOI: 10.7507/1002-1892.201711118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/25/2018] [Indexed: 11/03/2022]
Abstract
Objective To investigate pathogenesis, diagnosis, and treatment of crush syndrome of chest and arm. Methods Between January 2010 and January 2015, 5 cases of crush syndrome of chest and arm caused by pressing oneself in a coma after CO poisoning or alcoholic intoxication were treated. There were 4 males and 1 female with an average age of 36.7 years (range, 28-46 years). Two patients involved left upper limb and chest, while the other three patients involved right upper limb and chest. The crushed time ranged from 4 to 12 hours (mean, 7 hours). All 5 cases received emergency decompression and vacuum sealing drainage (VSD). After surgery, the patients were transferred to Intensive Care Unit to receive continuous renal replacement therapy (CRRT). The wounds were repaired with skin grafts after the patients' condition were stable. Results The hospitalization time was 26-48 days (mean, 33 days). Necrosis of the skin graft occurred in 1 case, which cured after debridement and skin graft again. The skin graft survived in the other cases and the wounds healed by first intension. Five patients were followed up 12-18 months (mean, 15 months). At last follow-up, the results were excellent in all 5 cases according to the assessment criteria proposed by GU Yudong. The patients got full recovery of their upper limb activities and sensation. All the patients returned to the normal life and work. Conclusion CO poisoning, drunkenness, and pressing oneself together will lead the crush syndrome to severe and rapid progress. The key of the treatment is a comprehensive therapy including a thorough and rapid tension reduction to save the limb function, CRRT, and correction of anemia and electrolyte imbalance.
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Affiliation(s)
| | - Ge Xiong
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035,
| | - Chunlin Zhang
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| | - Zirun Xiao
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
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Acar D, Gülpembe M, Yıldız CG, Özdamar EN, Açıkgöz K, Çağlar A, Cander B. The reno-protective effects of atorvastatin in crush syndrome and rhabdomyolysis:is there a dilemma? Turk J Med Sci 2017; 47:1920-1924. [PMID: 29306258 DOI: 10.3906/sag-1610-48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: We aim to determine the effects of low-dose atorvastatin treatment together with crush fluid resuscitation on renal functions and muscle enzyme levels in a rat model of crush syndrome. Materials and methods: The study involved female Wistar Albino rats weighing 250-300 g that were housed with free access to food and water. The crush model was obtained by compression. Rats were randomly divided into four groups: control (C) group, atorvastatin + crush fluid (ACF) group, crush fluid (CF) group, and hypertonic saline (%3) + mannitol + sodium bicarbonate (SM) group. Blood was obtained at 24, 48, and 72 h, and serum creatinine kinase, myoglobin, urea, creatinine, and lactate dehydrogenase levels were studied.Results: All parameters were statistically significantly higher in the control group than in the treatment groups at all hours. However, there was no statistically significant difference among treatment groups regarding any of the parameters.Conclusion: This is the first study determining the role of atorvastatin in the treatment of renal ischemia/reperfusion injury in a crush syndrome and rhabdomyolysis model setting. Larger studies with different atorvastatin doses are required to define the role of this drug in the treatment of renal ischemia/reperfusion injury during crush syndrome.
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Murata I, Abe Y, Yaginuma Y, Yodo K, Kamakari Y, Miyazaki Y, Baba D, Shinoda Y, Iwasaki T, Takahashi K, Kobayashi J, Inoue Y, Kanamoto I. Astragaloside-IV prevents acute kidney injury and inflammation by normalizing muscular mitochondrial function associated with a nitric oxide protective mechanism in crush syndrome rats. Ann Intensive Care 2017; 7:90. [PMID: 28871521 PMCID: PMC5583140 DOI: 10.1186/s13613-017-0313-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/19/2017] [Indexed: 11/26/2022] Open
Abstract
Background Crush syndrome (CS) is a serious medical condition characterized by muscle cell damage resulting from decompression after compression (i.e., ischemia/reperfusion injury). A large number of CS patients develop cardiac failure, kidney dysfunction, and systemic inflammation, even when fluid therapy is administered. We evaluated whether the administration of astragaloside-IV (AS)-containing fluid improved survival by preventing kidney and muscular mitochondrial dysfunction in a rat model of CS. Results The CS model was generated by subjecting anesthetized rats to bilateral hind limb compression with a rubber tourniquet for 5 h. Rats were then randomly divided into four groups: (1) sham; (2) CS with no treatment; (3) CS with normal saline treatment; and (4) CS with normal saline + 10 mg/kg AS. AS-containing fluid improved kidney function by improving shock and metabolic acidosis in CS rats. In addition, there was a reduction in oxidative damage. The attenuation of hyperkalemia was significantly related to improving muscle injury via preventing mitochondrial dysfunction. Moreover, this mitochondria protection mechanism was related to the nitric oxide (NO) generated by activation of endothelial nitric oxide synthase, which provided an anti-oxidative and anti-inflammatory effect. Conclusions Treatment with AS-containing fluid led to a dramatic improvement in survival following CS because of direct and indirect anti-oxidative effects in the kidney, and improvements in mitochondrial dysfunction and inflammation owing to AS acting as an NO donor in injured muscle. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0313-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isamu Murata
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan.
| | - Yuji Abe
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Yuka Yaginuma
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Kayako Yodo
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Yuka Kamakari
- Water and Food Inspection Group, Saitama Prefectural Institute of Public Health, Saitama, Japan
| | - Yurika Miyazaki
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Daichi Baba
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Yuko Shinoda
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Toru Iwasaki
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Kunihiko Takahashi
- Hygiene Inspection Section, Koshigaya City Public Health Center, Saitama, Japan
| | - Jun Kobayashi
- Division of Pathophysiology, Department of Clinical Dietetics and Human Nutrition, Faculty of Pharmaceutical Science, Josai University, Saitama, Japan
| | - Yutaka Inoue
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Ikuo Kanamoto
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
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Rho YJ, Choe WJ. Double crush syndrome caused by cervical spondylosis and vertebral artery loop. Eur Spine J 2019; 28:292-6. [PMID: 28508239 DOI: 10.1007/s00586-017-5064-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 03/19/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this article is to report a successful treatment experience in a rare case of simultaneous cervical nerve root compression by spondylotic cervical foraminal stenosis and a vertebral artery loop. METHODS 51-year-old man presented with a 4-year history of left-sided cervical pain radiating to the left shoulder with progressive exacerbation of weakness on left shoulder girdle muscles for 7 months. The patient had no history of trauma. The patient's CT and MRI revealed impingement of the left C6 cervical nerve root by a tortuous vertebral artery loop and also by narrowed left C5-6 cervical foramen that had undergone spondylotic changes. The patient underwent left C5-6 hemilaminectomy, facetectomy and C5-6 fusion. The procedures were uneventful, and the patient recovered with complete resolution of symptoms. RESULTS The patient continued to be asymptomatic at a 2-year follow-up examination, and the muscle mass of his left girdle returned normal. CONCLUSIONS This report illustrates the first phenomenon of a double crush syndrome caused by vertebral artery loop and cervical spondylotic changes. When patients with cervical spondylosis present with unexplainably severe pain and weakness, additional underlying pathologies should be considered when making differential diagnoses. The investigation planning should involve electromyography, computed tomography angiography, and magnetic resonance imaging.
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Cervellin G, Comelli I, Benatti M, Sanchis-Gomar F, Bassi A, Lippi G. Non-traumatic rhabdomyolysis: Background, laboratory features, and acute clinical management. Clin Biochem 2017; 50:656-662. [PMID: 28235546 DOI: 10.1016/j.clinbiochem.2017.02.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 12/11/2022]
Abstract
Rhabdomyolysis is a relatively rare condition, but its clinical consequences are frequently dramatic in terms of both morbidity and mortality. Although no consensus has been reached so far about the precise definition of this condition, the term rhabdomyolysis describes a rapid breakdown of striated, or skeletal, muscle. It is hence characterized by the rupture and necrosis of muscle fibers, resulting in release of cell degradation products and intracellular elements within the bloodstream and extracellular space. Notably, the percentage of patients with rhabdomyolysis who develop acute kidney injury, the most dramatic consequence, varies from 13% to over 50% according to both the cause and the clinical and organizational setting where they are diagnosed. Despite direct muscle injury (i.e., traumatic rhabdomyolysis) remains the most common cause, additional causes, frequently overlapping, include hypoxic, physical, chemical or biological factors. The conventional triad of symptoms includes muscle pain, weakness and dark urine. The laboratory diagnosis is essentially based on the measurement of biomarkers of muscle injury, being creatine kinase (CK) the biochemical "gold standard" for diagnosis, and myoglobin the "gold standard" for prognostication, especially in patients with non-traumatic rhabdomyolysis. The essential clinical management in the emergency department is based on a targeted intervention to manage the underlying cause, combined with infusion of fluids and eventually sodium bicarbonate. We will present and discuss in this article the pathophysiological and clinical features of non-traumatic rhabdomyolysis, focusing specifically on Emergency Department (ED) management.
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Affiliation(s)
| | - Ivan Comelli
- Emergency Department, Academic Hospital of Parma, Parma, Italy
| | - Mario Benatti
- Emergency Department, Academic Hospital of Parma, Parma, Italy
| | - Fabian Sanchis-Gomar
- NYU Langone Medical Center, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, USA; Department of Physiology, Faculty of Medicine, University of Valencia and Fundación Investigación Hospital Clínico Universitario de Valencia, Instituto de Investigación INCLIVA, Valencia, Spain
| | - Antonella Bassi
- Laboratory of Clinical Chemistry and Hematology, University Hospital of Verona, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Chemistry, University of Verona, Verona, Italy
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Abstract
The main goals of treating severe crush injuries are debriding away devitalized tissue and filling any resultant dead space with vascularized tissue. In the authors' experience, the most ideal methods for soft tissue coverage in treating crush injuries are the iliac flap, the adipofascial lateral arm flap, and the gracilis flap. Accompanying bone defects respond very well to free corticoperiosteal flaps. Digital defects often require the use of complete or subtotal toe transfer to avoid amputation and restore function to the hand.
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Affiliation(s)
- Francisco Del Piñal
- Instituto de Cirugía Plástica y de la Mano, Private Practice, Hospital La Luz and Hospital Mutua Montañesa, Madrid/Santander, Spain.
| | - Esteban Urrutia
- Instituto de Cirugía Plástica y de la Mano, Private Practice, Hospital La Luz and Hospital Mutua Montañesa, Madrid/Santander, Spain; Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Maciej Klich
- Instituto de Cirugía Plástica y de la Mano, Private Practice, Hospital La Luz and Hospital Mutua Montañesa, Madrid/Santander, Spain; Department of Traumatology and Orthopedics, Clinical Hospital, Warsaw, Otwock, Poland
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Zhang C, Wang X, Tang J. Evaluation of Acute Kidney Injury Using Contrast Ultrasonography in a Rabbit Model of Crush Syndrome. Ultrasound Med Biol 2017; 43:494-499. [PMID: 27887768 DOI: 10.1016/j.ultrasmedbio.2016.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 09/01/2016] [Accepted: 09/08/2016] [Indexed: 06/06/2023]
Abstract
This study aimed to investigate the feasibility of evaluating acute kidney injury (AKI) using contrast ultrasonography in a rabbit model of crush syndrome. Sixty-four New Zealand white rabbits were anesthetized and the left hind limb was wrapped and compressed for 4 h with a sphygmomanometer. Contrast ultrasonography of the left kidney using microbubbles as the contrast medium was performed. The serum levels of blood urea nitrogen (BUN), creatine (Cr), creatine kinase (CK) and lactate dehydrogenase (LDH) were significantly increased in comparison to before the compression. Correlation analysis showed that peak intensity was negatively correlated with the biochemical parameters and area under the curve (AUC) was positively correlated with these parameters. Contrast ultrasonography is thus sensitive to the changes in renal perfusion after limb crush injury in rabbits. The ultrasonography results correlated well with the biochemical parameters that are related to muscle injury and AKI.
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Affiliation(s)
- Chundong Zhang
- Department of Ultrasound, PLA Bethune International Peace Hospital, Shijiazhuang, China.
| | - Xin Wang
- Department of Pediatrics, PLA Bethune International Peace Hospital, Shijiazhuang, China
| | - Jie Tang
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
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Zorova LD, Pevzner IB, Chupyrkina AA, Zorov SD, Silachev DN, Plotnikov EY, Zorov DB. The role of myoglobin degradation in nephrotoxicity after rhabdomyolysis. Chem Biol Interact 2016; 256:64-70. [PMID: 27329933 DOI: 10.1016/j.cbi.2016.06.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/31/2016] [Accepted: 06/17/2016] [Indexed: 12/18/2022]
Abstract
The fate of myoglobin in renal cells was explored in an animal model of rhabdomyolysis known as the pathology highly related to oxidative stress resulting in impairment of renal functioning. The working hypothesis was that the proper degradation of myoglobin in rhabdomyolytic kidney can activate the reparative processes in the tissue. We found that incubation of myoglobin with kidney cells causes its accumulation in the cytoplasm. In rhabdomyolytic rats, the level of heme and free iron in cytoplasm and mitochondria of kidney cells is remarkably increased while inhibition of proteolysis results in further elevation of myoglobin content in the renal tissue. Heme oxygenase and ferritin levels were found to be increased in the kidney tissue at rhabdomyolysis and simulating conditions performed by i/v injection of myoglobin. In addition, the level of peroxidized lipids was high in rhabdomyolytic kidney and became even higher after inhibition of proteolysis by aprotinin. Elevated levels of carbonylated proteins were also observed after rhabdomyolysis, however, if prior to induction of rhabdomyolysis the injection of myoglobin was done, the level of carbonylated proteins dropped versus unprimed kidney tissue thus affording protection to the kidney against oxidative stress. Injection of myoglobin to the rat results in impairment of renal functioning and inhibition of myoglobin degradation in the rhabdomyolytic animal aggravates acute renal failure, demonstrating that degradation of myoglobin is somehow beneficial although it may result in undesired release of free iron which can participate in toxic redox cycling.
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Affiliation(s)
- Ljubava D Zorova
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992, Leninskye Gory, House 1, Building 40, Moscow, Russia; International Laser Center, Lomonosov Moscow State University, 119992, Leninskye Gory, House 1, Building 62, Moscow, Russia
| | - Irina B Pevzner
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992, Leninskye Gory, House 1, Building 40, Moscow, Russia
| | - Anastasia A Chupyrkina
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992, Leninskye Gory, House 1, Building 40, Moscow, Russia
| | - Savva D Zorov
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, 119992, Leninskye Gory, House 1, Building 73, Moscow, Russia
| | - Denis N Silachev
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992, Leninskye Gory, House 1, Building 40, Moscow, Russia
| | - Egor Y Plotnikov
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992, Leninskye Gory, House 1, Building 40, Moscow, Russia.
| | - Dmitry B Zorov
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992, Leninskye Gory, House 1, Building 40, Moscow, Russia.
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Song J, Ding H, Fan HJ, Dong WL, Sun ZX, Hou SK. Canine model of crush syndrome established by a digital crush injury device platform. Int J Clin Exp Pathol 2015; 8:6117-6125. [PMID: 26261489 PMCID: PMC4525823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/25/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To establish a canine model of crush syndrome (CS). METHODS A total of 16 healthy adult female Beagle dogs were randomly divided into the control group (n=8) and the experimental group (n=8). The crush injury was created in the left hind leg of each dog in the experimental group. RESULTS The biochemical indexes in the experimental group changed significantly compared to the values before extrusion. And they were also significantly different from the values of the control group. The glomerular capillary dilation, renal tubular epithelial cell degeneration, and renal interstitial lymphocytic infiltration were found in the kidneys. CONCLUSION The canine CS model established by the digital crush injury device platform was successful according with the diagnosis of CS. It is good for the investigation of the CS mechanism and treatment using this model.
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Affiliation(s)
- Jie Song
- Tianjin Medical UniversityTianjin 300162, P. R. China
- Key Laboratory of Emergency and Disaster Medicine in Chinese People’s Liberation Army, Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistics University of Chinese People’s Army Police ForcesTianjin 300162, P. R. China
- Department of Nephrology, Affiliated Hospital of Logistics University of Chinese People’s Armed Police ForcesTianjin 300162, P. R. China
| | - Hui Ding
- Key Laboratory of Emergency and Disaster Medicine in Chinese People’s Liberation Army, Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistics University of Chinese People’s Army Police ForcesTianjin 300162, P. R. China
| | - Hao-Jun Fan
- Key Laboratory of Emergency and Disaster Medicine in Chinese People’s Liberation Army, Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistics University of Chinese People’s Army Police ForcesTianjin 300162, P. R. China
| | - Wen-Long Dong
- Key Laboratory of Emergency and Disaster Medicine in Chinese People’s Liberation Army, Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistics University of Chinese People’s Army Police ForcesTianjin 300162, P. R. China
| | - Zhen-Xing Sun
- Key Laboratory of Emergency and Disaster Medicine in Chinese People’s Liberation Army, Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistics University of Chinese People’s Army Police ForcesTianjin 300162, P. R. China
| | - Shi-Ke Hou
- Key Laboratory of Emergency and Disaster Medicine in Chinese People’s Liberation Army, Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistics University of Chinese People’s Army Police ForcesTianjin 300162, P. R. China
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Kong DY, Hao LR, Zhang L, Li QG, Zhou JH, Shi SZ, Zhu F, Geng YQ, Chen XM. Comparison of two fluid solutions for resuscitation in a rabbit model of crush syndrome. Clin Exp Nephrol 2015; 19:1015-23. [PMID: 25910455 DOI: 10.1007/s10157-015-1114-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 04/07/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Crush syndrome is a common injury, the main characteristics of which include acute kidney injury. However, there is still lack of reliable animal model of crush syndrome, and it also remains controversial as to which type of fluid should be chosen as a more appropriate treatment option for prevention and treatment of acute kidney injury. METHODS The rabbits were crushed at the lower limbs for 6 h with 36 times the body weight, which means the pressure of each leg was also 36 times the body weight. Fluid resuscitation was performed from 1 h prior to the end of the crush treatment until 24 h after the reperfusion. Tissue, blood and urine samples were collected at predetermined time points before and after reperfusion. Twelve rabbits in each group were taken for survival observation for 72 h. RESULTS The model group showed elevated serum creatine kinase, aspartate aminotransferase, alanine aminotransferase, and K(+) level, reduced serum Ca(2+) level and Na(+) level, and increased serum creatinine and blood urea nitrogen levels, neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1 (p < 0.05). The 0.9 % normal saline (SAL) group and SAL plus 6 % hydroxyethyl starch 130/0.4 SAL/HES group showed reduced serum creatinine and blood urea nitrogen levels (p < 0.05). The SAL/HES group also showed reduced serum IL-6 and IL-10 levels (p < 0.05). The 72 h survival rate of the SAL/HES group was higher than that of the model group (p < 0.05). CONCLUSION The rabbit model of crush syndrome showed clinical features consistent with those of crush syndrome. There was no significant difference in the ability of preventing AKI after a crush injury between the two fluid solutions, while SAL/HES can improve the survival rate.
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Affiliation(s)
- De-yang Kong
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
- Department of Nephrology, 1st Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li-rong Hao
- Department of Nephrology, 1st Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li Zhang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China.
| | - Qing-gang Li
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
| | - Jian-hui Zhou
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
| | - Suo-zhu Shi
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
| | - Fei Zhu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
| | - Yan-qiu Geng
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
| | - Xiang-mei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China.
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Takikawa M, Nakamura S, Ishihara M, Takabayashi Y, Fujita M, Hattori H, Kushibiki T, Ishihara M. Improved angiogenesis and healing in crush syndrome by fibroblast growth factor-2-containing low-molecular-weight heparin (Fragmin)/protamine nanoparticles. J Surg Res 2015; 196:247-57. [PMID: 25864985 DOI: 10.1016/j.jss.2015.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/22/2015] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND We produced fibroblast growth factor (FGF)-2-containing low-molecular-weight heparin (Fragmin)/protamine nanoparticles (FGF-2 + F/P NPs). The purpose of this study was to evaluate the effectiveness of the local administration of FGF-2 + F/P NPs on repairing crush syndrome (CS)-injured lesions after compression release using a nonlethal and reproducible CS injury rat model. MATERIALS AND METHODS The hind limbs of the anesthetized rats were compressed for 6 h using 3.6 kg blocks, as previously described. The effects of administering FGF-2 + F/P NPs (group A), F/P NPs alone (group B), FGF-2 alone (group C), and saline (control; group D) were examined. Motor function, surface blood flow in the hind limbs, and the wet/dry weight ratio in the tibialis anterior muscle were examined for 1-28 d after the compression release. Histologic analyses were also performed. RESULTS At the middle and late stages (3-28 d after the compression release), group A had higher scores in the motor function, improved blood flow, increased number of blood vessels, and faster recovered muscle tissue, compared with the other groups. There was no significant difference in enhanced edema in the tibialis anterior muscle among all groups. CONCLUSIONS The local administration of FGF-2 + F/P NPs to a CS-injured lesion was effective in repairing damaged muscle tissue after compression release.
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Affiliation(s)
- Makoto Takikawa
- Department of Medical Engineering, National Defense Medical College, Tokorozawa, Japan
| | - Shingo Nakamura
- Research Institute, National Defense Medical College, Tokorozawa, Japan
| | - Masayuki Ishihara
- Research Institute, National Defense Medical College, Tokorozawa, Japan.
| | - Yuki Takabayashi
- Department of Plastic Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Masanori Fujita
- Research Institute, National Defense Medical College, Tokorozawa, Japan; Second Division, Aeromedical Laboratory, Japan Air Self-Defense Force, Tachikawa, Japan
| | - Hidemi Hattori
- Research Institute, National Defense Medical College, Tokorozawa, Japan
| | - Toshihiro Kushibiki
- Department of Medical Engineering, National Defense Medical College, Tokorozawa, Japan
| | - Miya Ishihara
- Department of Medical Engineering, National Defense Medical College, Tokorozawa, Japan
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Sgarbi MW, Silva Júnior BA, Peres CM, Loureiro TC, Curi R, Soriano FG, Ribeiro DA, Velasco IT. Plasma cytokine expression after lower-limb compression in rats. Rev Bras Ortop 2015; 50:105-9. [PMID: 26229886 DOI: 10.1016/j.rboe.2014.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 01/23/2014] [Indexed: 11/28/2022] Open
Abstract
Objectives Muscle injury due to crushing (muscle compression injury) is associated with systemic manifestations known as crush syndrome. A systemic inflammatory reaction may also be triggered by isolated muscle injury. The aim of this study was to investigate the plasma levels of interleukins (IL) 1, 6 and 10 and tumor necrosis factor alpha (TNF-α), which are markers for possible systemic inflammatory reactions, after isolated muscle injury resulting from lower-limb compression in rats. Methods Male Wistar rats were subjected to 1 h of compression of their lower limbs by means of a rubber band. The plasma levels of IL 1, 6 and 10 and TNF-α were measured 1, 2 and 4 h after the rats were released from compression. Results The plasma levels of IL 10 decreased in relation to those of the other groups, with a statistically significant difference (p < 0.05). The method used did not detect the presence of IL 1, IL 6 or TNF-α. Conclusion Our results demonstrated that the changes in plasma levels of IL 10 that were found may have been a sign of the presence of circulating interleukins in this model of lower-limb compression in rats.
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Sene GAL, Sousa FFDA, Fazan VS, Barbieri CH. Effects of laser therapy in peripheral nerve regeneration. Acta Ortop Bras 2014; 21:266-70. [PMID: 24453680 PMCID: PMC3874995 DOI: 10.1590/s1413-78522013000500005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 02/05/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: The influence of dose of low power lasertherapy (AsGaAl, 830 nm) on the regeneration of the fibular nerve of rats after a crush injury was evaluated by means of the functional gait analysis and histomorphometric parameters. METHODS: Controlled crush injury of the right common fibular nerve, immediately followed by increasing doses (G1: no irradiation; G2: simulated; G3: 5 J/cm2; G4: 10 J/cm2; G5: 20 J/cm2) laser irradiation directly on the lesion site for 21 consecutive days. Functional gait analysis was carried out at weekly intervals by measuring the peroneal/fibular functional index (PFI). The animals were killed on the 21st postoperative day for removal of the fibular nerve, which was prepared for the histomorphometric analysis. RESULTS: The PFI progressively increased during the observation period in all groups, without significant differences between them (p>0.05). The transverse nerve area was significantly wider in group 2 than in groups 3 and 4, while fiber density was significantly greater in group 4 than in all remaining groups. CONCLUSION: The low power AsGaAl laser irradiation did not accelerate nerve recovery with any of the doses used. Level of Evidence I, Therapeutic Studies Investigating the Results of Treatment.
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Boukatta B, El Bouazzaoui A, Houari N, Jiber H, Sbai H, Kanjaa N. [Traumatic compression syndrome: report of a case]. Pan Afr Med J 2014; 19:242. [PMID: 25848457 PMCID: PMC4377290 DOI: 10.11604/pamj.2014.19.242.3361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 10/11/2014] [Indexed: 11/11/2022] Open
Abstract
Le crush syndrome correspond à l'ensemble des manifestations systémiques secondaire à une destruction des fibres musculaires striées. Il survient le plus souvent dans le cadre d'accidents graves tels que les catastrophes, accidents de travail et accidents de la voie publique. Il est responsable d'une hypovolémie, état de choc, hyperkaliémie, hypocalcémie, acidose métabolique et d'insuffisance rénale aigue. Le succès du traitement dépend largement de la rapidité de la prise en charge. Les principaux objectifs thérapeutiques sont la correction de l'hypovolémie, traitement de l'hyperkaliémie, l'alcalinisation et la prévention de l'insuffisance rénale. L'utilisation de garrots compressifs doit être réservée au seul contrôle d'hémorragies importantes. Dans cet article, nous rapportons le cas d'un jeune patient de 20 ans ayant présenté un crush syndrome à la suite d'un accident de la voie publique. L’évolution était favorable, mais une amputation du membre écrasé était nécessaire.
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Affiliation(s)
- Brahim Boukatta
- Université Sidi Mohammed Ben Abdellah, Service de Réanimation polyvalente du CHU Hassan II de Fès, Maroc
| | - Abderrahim El Bouazzaoui
- Université Sidi Mohammed Ben Abdellah, Service de Réanimation polyvalente du CHU Hassan II de Fès, Maroc
| | - Nawfal Houari
- Université Sidi Mohammed Ben Abdellah, Service de Chirurgie Vasculaire du CHU Hassan II de Fès, Maroc
| | - Hamid Jiber
- Université Sidi Mohammed Ben Abdellah, Service de Chirurgie Vasculaire du CHU Hassan II de Fès, Maroc
| | - Hicham Sbai
- Université Sidi Mohammed Ben Abdellah, Service de Réanimation polyvalente du CHU Hassan II de Fès, Maroc
| | - Nabil Kanjaa
- Université Sidi Mohammed Ben Abdellah, Service de Réanimation polyvalente du CHU Hassan II de Fès, Maroc
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Abstract
After direct impact of the trauma, crush syndrome is the second most frequent cause of death after mass disasters. However, since crush syndrome is quite rare in daily practice, mistakes are frequent in the treatment of these cases. This paper summarizes the etiopathogenesis of traumatic rhabdomyolysis and of crush syndrome-based acute kidney injury. The clinical and laboratory features, prophylaxis, and treatment of crush cases are described as well. The importance of early and energetic fluid resuscitation is underlined for prophylaxis of acute kidney injury. Since there is chaos, and an overwhelming number of victims, logistic drawbacks create a specific problem in the treatment of crush victims after mass disasters. Potential solutions for logistic hurdles and disaster preparedness scenarios have also been provided in this review article.
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Affiliation(s)
- Mehmet Sukru Sever
- Local co-ordinator for the Renal Disaster Relief Task Force of the
International Society of Nephrology (ISN); Department of Internal Medicine/Nephrology,
Istanbul School of Medicine, Istanbul, Turkey, and
- To whom correspondence should be addressed: E-mail:
| | - Raymond Vanholder
- Chairman, Renal Disaster Relief Task Force of the ISN; Renal Division,
Department of Internal Medicine, University Hospital, Ghent, Belgium
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Abstract
Combat related injuries bring untold misery to the victims and their loved ones. While injuries to vital organs cause immediate death, delayed mortality after reaching a hospital may occur due to several reasons, rhabdomyolysis or the crush syndrome being the most important. Crush syndrome predominantly affects the kidneys leading to renal failure, but the clinical picture may include acute respiratory distress syndrome, dyselectrolytaemia, disseminated intravascular coagulation, hypovolemic shock, arrhythmias and psychological trauma. Rescue, resuscitation and rehabilitation are onerous tasks and so a coordinated strategy with well trained team of professionals through various chains of evacuation is advocated. This article addresses these issues drawing upon the experience of the writer in combat casualty care in active operations.
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Affiliation(s)
- S Rajagopalan
- Professor and HOD, Department of Surgery, Armed Forces Medical College, Pune-40
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