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Purpose Microbial infection stimulates neutrophil/macrophage/monocyte extracellular trap formation, which leads to the release of citrullinated histone H3 (CitH3) catalyzed by peptidylarginine deiminase (PAD) 2 and 4. Understanding these molecular mechanisms in the pathogenesis of septic shock will be an important next step for developing novel diagnostic and treatment modalities. We sought to determine the expression of CitH3 in patients with septic shock, and to correlate CitH3 levels with PAD2/PAD4 and clinically relevant outcomes. Methods Levels of CitH3 were measured in serum samples of 160 critically ill patients with septic and non-septic shock, and healthy volunteers. Analyses of clinical and laboratory characteristics of patients were conducted. Results Levels of circulating CitH3 at enrollment were significantly increased in septic shock patients (n = 102) compared to patients hospitalized with non-infectious shock (NIC) (n = 32, p r = 0.36, p p p Conclusion CitH3 is increased in patients with septic shock. Its serum concentrations correlate with disease severity and prognosis, which may yield vital insights into the pathophysiology of sepsis.

Military physicians have amassed tremendous experience treating children with combat-related injuries in Iraq and Afghanistan. This review will present several treatment principles adapted from adult trauma care that were applied to children in war and consider their selective application in civilian practice. Many standard practices of adult trauma care were applied to the management of war-injured children. Initial reports of tourniquet use, tranexamic acid administration, and balanced blood transfusion suggest a benefit to the pediatric population. Constraints of providing intensive care in an austere environment required a shift in management toward aggressive limb salvage over amputation, and early palliation for severe brain injury or extensive burns. Despite the obstacles that may limit the direct translation of trauma care principals to civilian settings, these wartime experiences offer robust and excellent preliminary data that might inform future investigations in the field of pediatric trauma care.