Immunomodulatory effects of plasma products on monocyte function in vitro.

BACKGROUND: Restoration of a balanced innate immune response is paramount to recovery from critical injury. Plasma transfusion may modulate innate immune responses; however, little is known about the immunomodulatory potential of various plasma products. We conducted in vitro experiments to determine the effects of fresh frozen plasma, thawed plasma, solvent/detergent plasma, and an investigational spray-dried solvent/detergent plasma product on monocyte function. METHODS: Monocytes were isolated from healthy adult volunteers and cocultured with aliquots of autologous plasma (control), fresh frozen plasma, thawed plasma, solvent/detergent treated plasma, or spray-dried solvent/detergent plasma. Monocyte function was assessed by cytokine production with and without lipopolysaccharide (LPS) stimulation, and flow cytometric assessment of HLA-DR cell surface expression. RESULTS: Monocyte cytokine production was not significantly altered after exposure to fresh frozen plasma or thawed plasma. In the absence of LPS, spray-dried solvent/detergent plasma exposure resulted in markedly increased IL-8 production compared to other plasma groups and controls (p = 0.01, analysis of variance [ANOVA]). Likewise, spray-dried SD plasma exposure resulted in higher LPS-induced IL-8, TNFα, and IL-1ß production compared with autologous plasma controls (p < 0.0001; p < 0.0001, p = 0.002, respectively; ANOVA). LPS-induced IL-8 and TNFα production was lowest after exposure to solvent/detergent plasma (p < 0.0001, ANOVA). CONCLUSION: Exposure to spray-dried solvent/detergent plasma resulted in marked augmentation of monocyte inflammatory cytokine production. Solvent/detergent plasma exposure resulted in the lowest cytokine production, suggesting lower immunomodulatory potential. Further work is needed to determine how these in vitro findings may translate to the bedside.

Epidemiology of pediatric hand injuries presenting to United States emergency departments, 1990 to 2009.

BACKGROUND: The goal of this study is to describe the epidemiology of hand injuries among children treated in US emergency departments (EDs), including the consumer products and activities most commonly associated with these injuries. METHODS: A retrospective analysis was conducted of data from the National Electronic Injury Surveillance System for patients younger than 18 years, who were treated in an ED for hand injuries from 1990 through 2009. Sample weights were applied to calculate national estimates, and US Census Bureau data were used to determine injury rates. RESULTS: An estimated 16,373,757 (95% confidence interval: 14,082,965-18,664,551) children younger than 18 years were treated in EDs for hand injuries from 1990 through 2009 with a mean annual injury number of 818,688 and rate of 11.6 per 1,000 population. There was a statistically significant decrease in the annual number (by 20.5%) and rate (by 31.5%) of hand injuries during the 20-year study period. Males accounted for 65.3% of hand injuries. Injuries most commonly occurred in the home (57.7%) and were most frequently diagnosed as lacerations (31.3%). Patients aged 10 years to 14 years were most frequently diagnosed with fractures (26.7%) and were 1.71 (95% confidence interval: 1.68-1.75) times more likely to be diagnosed with a fracture than patients in other age groups. Hand injuries commonly occurred with products/activities associated with sports/recreational activities (36.4%). CONCLUSION: Hand injuries are a common and preventable source of pediatric morbidity. Prevention efforts should target the home environment and sport/recreational activities. LEVEL OF EVIDENCE: Epidemiological study, level III.