Factors Associated With Prolonged Mechanical Ventilation and Reventilation in Acute Cervical Spinal Cord Injury Patients.

MINI: In this study, respiratory function at the time of extubation can be useful optimal clinical guidelines for weaning and extubation attempts in patients with acute cervical spinal cord injury. Serum thiobarbituric acid-reactive substances level at admission can be a useful predictor for severity in acute cervical patients with spinal cord injury. STUDY DESIGN: Patients who had suffered from acute blunt cervical spinal cord injury (SCI) and admitted our hospital within 24 hours after injury were included in the study. OBJECTIVE: We compared the respiratory function and serum reactive oxidative stress (ROS) after acute cervical SCI, and tried to find out the valuable predictors of weaning in patients with acute cervical SCI. SUMMARY OF BACKGROUND DATA: Ventilation impairment is a major complication of acute cervical SCI. Evidence of oxygen radical formation in secondary injury from animal SCI models demonstrates an immediate postinjury increase in ROS production after SCI. We hypothesize that the serum ROS is associated with the severity of patients with acute cervical SCI. METHODS: Thirty-eight adult patients who had acute cervical SCI and 58 healthy volunteers were enrolled. Respiratory function at admission, at the time of extubation and at 48 hours after extubation, serum oxidative stress, Injury Severity Score and Japanese Orthopaedic Association score at admission were compared. RESULTS: The most notable predictor of mechanical ventilation more than 48 hours was serum thiobarbituric acid-reactive substances (TBARS) level at admission (P = 0.027), and the cut-off value of serum TBARS level was 731.7 µmol/L (sensitivity 87.5% and specificity 78.9%). For the reventilation ≤5 days, the notable predictors were respiratory function at the time of extubation (maximal inspiratory pressure, P = 0.040; maximal expiratory pressure, P = 0.020; and tidal volume, P = 0.036) and serum TBARS level at admission (P = 0.013), the cut-off value of serum TBARS level at admission was 762.3 µmol/L (sensitivity 100% and specificity 90.0%). CONCLUSION: In this study, respiratory function (maximal inspiratory pressure, maximal expiratory pressure, and tidal volume) at the time of extubation can be useful optimal clinical guidelines for weaning and extubation attempts in patients with acute cervical SCI. Serum TBARS level at admission can be a useful predictor for severity in acute cervical SCI patients. LEVEL OF EVIDENCE: 3.

Patients who had suffered from acute blunt cervical spinal cord injury (SCI) and admitted our hospital within 24 hours after injury were included in the study. We compared the respiratory function and serum reactive oxidative stress (ROS) after acute cervical SCI, and tried to find out the valuable predictors of weaning in patients with acute cervical SCI. Ventilation impairment is a major complication of acute cervical SCI. Evidence of oxygen radical formation in secondary injury from animal SCI models demonstrates an immediate postinjury increase in ROS production after SCI. We hypothesize that the serum ROS is associated with the severity of patients with acute cervical SCI. Thirty-eight adult patients who had acute cervical SCI and 58 healthy volunteers were enrolled. Respiratory function at admission, at the time of extubation and at 48 hours after extubation, serum oxidative stress, Injury Severity Score and Japanese Orthopaedic Association score at admission were compared. The most notable predictor of mechanical ventilation more than 48 hours was serum thiobarbituric acid-reactive substances (TBARS) level at admission (P = 0.027), and the cut-off value of serum TBARS level was 731.7 µmol/L (sensitivity 87.5% and specificity 78.9%). For the reventilation ≤5 days, the notable predictors were respiratory function at the time of extubation (maximal inspiratory pressure, P = 0.040; maximal expiratory pressure, P = 0.020; and tidal volume, P = 0.036) and serum TBARS level at admission (P = 0.013), the cut-off value of serum TBARS level at admission was 762.3 µmol/L (sensitivity 100% and specificity 90.0%). In this study, respiratory function (maximal inspiratory pressure, maximal expiratory pressure, and tidal volume) at the time of extubation can be useful optimal clinical guidelines for weaning and extubation attempts in patients with acute cervical SCI. Serum TBARS level at admission can be a useful predictor for severity in acute cervical SCI patients. Level of Evidence: 3.

[Chronology of a homicide and an attempted suicide by DNA analysis of selected blood stains on the weapon (knife)]]. / Untersuchungen zur Chronologie eines Tötungsdeliktes und eines Suizidversuches durch DNA-Analyse von ausgewählten Blutspuren am Tatwerkzeug (Messer).

A five-year-old boy was fatally injured by a stab and a cut to the throat. The suspected offender, an acquaintance of the victim's mother, stated that he had been disturbed by the boy while attempting suicide and had therefore killed the boy. The suspect showed superficial cuts on both wrists and three shallow stabs on the right-hand side of the abdomen. The purpose of the forensic investigations was to answer the question if the suspect's statement could be confirmed or if the attempted suicide took place after killing the boy. The blood-smeared blade of the knife was divided into different sectors with the cutting edge and the tip of the blade being examined separately from the sides. The blood traces from the different blade sectors were then typed in 12 different DNA regions by PCR (polymerase-chain-reaction). It could be demonstrated that the strong blood traces on the sides of the blade originated from the victim alone, whereas in the area of the edge and the tip of the blade the amount of the victim's blood was negligible compared with that of the suspected offender. The explanation for this finding is that in the areas of the edge and the tip of the knife the blood of the victim must have been replaced by the blood of the suspected perpetrator, which means that the suicidal injuries were the last to be caused by the knife.

Correlation between serum IL-6 levels and death: usefulness in diagnosis of "traumatic shock"?

Interleukin-6 (IL-6) has been considered as an important mediator of inflammation. Clinically it is a well-known marker of the severity of injury following major trauma. In this study, the levels of IL-6 in body serum were applied to a traumatic death index. Of ninety victims 55 were men and 35 women, with a mean age of 53.4+/- 19 (S.D.) years. The cases were classified as traumatic deaths (38 cases), non-traumatic deaths other than natural causes of deaths (36 cases), and deaths due to natural causes (16 cases). All samples were collected within 2 days after death. The mean values of IL-6 levels of the traumatic, non-traumatic and disease groups were 8608.97, 2205.65, and 3266.64 pg/ml, respectively. Some cases in non-traumatic and disease cases were beyond 10 000 pg/ml, however, the mean value of the traumatic group was statistically higher than that of the other two groups. Even though several cases had high levels of IL-6 in spite of instantaneous death, the results showed that IL-6 levels are helpful in the diagnosis of traumatic shock.