Age and mortality after injury: is the association linear?

INTRODUCTION: Multiple studies have demonstrated a linear association between advancing age and mortality after injury. An inflection point, or an age at which outcomes begin to differ, has not been previously described. We hypothesized that the relationship between age and mortality after injury is non-linear and an inflection point exists. METHODS: We performed a retrospective cohort analysis at our urban level I center from 2007 through 2009. All patients aged 65 years and older with the admission diagnosis of injury were included. Non-parametric logistic regression was used to identify the functional form between mortality and age. Multivariate logistic regression was utilized to explore the association between age and mortality. Age 65 years was used as the reference. Significance was defined as p < 0.05. RESULTS: A total of 1,107 patients were included in the analysis. One-third required intensive care unit (ICU) admission and 48 % had traumatic brain injury. 229 patients (20.6 %) were 84 years of age or older. The overall mortality was 7.2 %. Our model indicates that mortality is a quadratic function of age. After controlling for confounders, age is associated with mortality with a regression coefficient of 1.08 for the linear term (p = 0.02) and a regression coefficient of -0.006 for the quadratic term (p = 0.03). The model identified 84.4 years of age as the inflection point at which mortality rates begin to decline. CONCLUSIONS: The risk of death after injury varies linearly with age until 84 years. After 84 years of age, the mortality rates decline. These findings may reflect the varying severity of comorbidities and differences in baseline functional status in elderly trauma patients. Specifically, a proportion of our injured patient population less than 84 years old may be more frail, contributing to increased mortality after trauma, whereas a larger proportion of our injured patients over 84 years old, by virtue of reaching this advanced age, may, in fact, be less frail, contributing to less risk of death.

Partial liver herniation into the right chest following trauma: a delayed presentation as acute injury managed by laparoscopically assisted mini-thoracotomy.

INTRODUCTION: Traumatic diaphragmatic rupture is a relatively uncommon occurrence, with an incidence of 0.8-5% reported in the literature. The reported percentage of missed diaphragmatic injuries that were discovered later ranges from 12 to 66%. Herniation of the liver through the right diaphragm has been reported in the literature after liver transplantation, and in trauma populations. MATERIALS AND METHODS: Here, we report a case of late identification of partial liver herniation into the right chest (8 years post initial injury), due to a recent motor vehicle crash. Thought to be suffering from an acute injury, the patient was taken to the operating room and a laparoscopically assisted mini-thoracotomy was performed. An old diaphragmatic injury was found intraoperatively; laparoscopically assisted mini-thoracotomy was used to repair the diaphragm, and the liver was returned into the abdomen. CONCLUSION: Right-sided diaphragmatic laceration, if diagnosed at the time of injury, may be repaired with the minimally invasive technique we describe here.

Ion pairing between Cl- or ClO4- and alkali metal complexes of ionophore antibiotics in organic solvents: a multinuclear NMR and FT-IR study.

The extent of ion pairing in chloride and perchlorate salts was studied by measurement of the Cl- and ClO4- resonances and the observation of the perchlorate stretching frequency by use of nuclear magnetic resonance (NMR) spectroscopy and Fourier transform infrared spectroscopy (FT-IR), respectively, for a variety of ionophores in various solutions and in large unilaminar vesicles (LUVs). The NMR line widths of chloride and perchlorate were larger in solutions containing the neutral ionophores valinomycin (Val) and nonactin (Non) than in solutions containing the negatively charged ionophores nigericin (Nig), lasalocid (Las), and monensin (Mon). The viscosity-corrected perchlorate NMR line widths in solutions containing Val and Las were significantly negatively correlated (r2 > or = 0.99) with the dielectric constant of the solvent. Solvents with low dielectric constants favored ion pair formation. From methanolic solutions containing the Li+, Na+, K+, and Cs+ salts of Cl- and ClO4-, it was determined that the cation with the highest selectivity for the ionophore affords the most ion pairing. A decrease in pH from 7 to 3 had no significant effect on the NMR line widths of chloride and perchlorate in methanolic solutions containing Val, whereas a similar decrease in pH in a methanolic solution containing Mon caused a 2-fold increase in the line widths. The FT-IR difference spectrum of KClO4 in a methanolic solution containing Val showed splitting at the perchlorate stretching frequency. No band splitting was observed in the FT-IR difference spectrum of KClO(4) in methanolic solutions containing Las. The efflux of 35Cl in LUVs containing the neutral ionophore Val followed first-order kinetics with an efflux constant of 1.70 x 10(-3) x min(-1), as determined by 35Cl NMR spectroscopy. The induction of increased membrane permeability in LUVs by the ionophore was determined to be negligible for Val and Nig by fluorescence spectroscopy.

Li+/Mg2+ competition at therapeutic intracellular Li+ levels in human neuroblastoma SH-SY5Y cells.

OBJECTIVES: One proposed mechanism of lithium action in the treatment of bipolar disorder is that Li+ competes with Mg2+ for Mg2+ binding sites within the cell. In this study, we investigated this competition at therapeutic intracellular Li+ levels in human neuroblastoma SH-SY5Y cells. METHODS: We used fluorescence spectroscopy and a Mg2+ indicator, furaptra, to investigate this competition in human neuroblastoma SH-SY5Y cells. Atomic absorption spectrophotometry was used for determination of the intracellular Li+ levels. RESULTS: The neuroblastoma cells, incubated in 15 mM or 30 mM Li+-containing buffer, showed a significant increase in free intracellular Mg2+ levels [using a positive linear within-groups contrast t-test, the 15 mM condition produced t(2) = 5.0, one-tailed p < 0.02, and the 30 mM Li+-incubation conditions gave t(2) = 9.2, one-tailed p < 0.006] but did not significantly increase over time in the Li+-free condition [t(2) = 0.1, one-tailed p > 0.96]. At the earlier times during the incubation (1 or 10 min for the 15 mM or 30 mM Li+-containing buffers), the intracellular Li+ concentrations were 0.6-2.5 mM, values which are comparable to those reached in the brain of Li+-treated patients. CONCLUSION: We demonstrated that competition between Li+ and Mg2+ can occur at therapeutic intracellular Li+ levels.