162 results on '"John L. Hunt"'
Search Results
2. Energy Content of Seeds of Switchgrass (Panicum virgatum) in the Diet of Mourning Doves (Zenaida macroura) in Southeastern New Mexico
- Author
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John L. Hunt, Matthew Grilliot, Troy Best, Faith Johnson, Tyneshia Kilgore, and Cade Wilkerson
- Published
- 2022
3. Energy Content of Seeds of Palmer's Pigweed (Amaranthus palmeri) in the Diet of Scaled Quail (Callipepla squamata) in Southeastern New Mexico
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John L. Hunt, Matthew Grilliot, Troy Best, Isaac Castillo, Paige Eddington, Faith Johnson, Tyneshia Kilgore, and Jacob Courson
- Published
- 2021
4. Energy Content of Seeds of Common Sunflowers (Helianthus annuus) in the Diet of Scaled Quail (Callipepla squamata) in Southeastern New Mexico
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Troy L. Best, Isaac C. Castillo, John L. Hunt, Matthew E. Grilliot, Dixie Lozano-Lopez, and Emily R. Neilson
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Squamata ,biology ,biology.animal ,Callipepla ,Helianthus annuus ,Botany ,Energy density ,biology.organism_classification ,Quail - Published
- 2020
5. Sexual Size Dimorphism in the Thirteen-Lined Ground Squirrel (Ictidomys tridecemlineatus)
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E. Gus Cothran, Troy L. Best, and John L. Hunt
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0106 biological sciences ,0301 basic medicine ,Sexual dimorphism ,03 medical and health sciences ,030104 developmental biology ,Thirteen-lined ground squirrel ,Zoology ,Biology ,010603 evolutionary biology ,01 natural sciences ,Ecology, Evolution, Behavior and Systematics ,Ictidomys tridecemlineatus - Abstract
We evaluated Ictidomys tridecemlineatus for sexual dimorphism by taking 40 skeletal measurements from 267 specimens from Texas, New Mexico, and Oklahoma. We compared measurements from males and females using discriminant-function analysis with included analyses of variance. Males and females were significantly different overall. Of the nine characters that were significantly different, eight were larger in males, while females had a greater sacrum width.
- Published
- 2017
6. Photographic Record of a Greater Roadrunner (Geococcyx californianus) from Drew County, Arkansas
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Christopher G. Sims and John L. Hunt
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Roadrunner ,Geography ,business.operation ,biology ,Geococcyx californianus ,Photographic record ,business ,biology.organism_classification ,Archaeology - Published
- 2019
7. Energy Content of Seeds of Texas Doveweed (Croton texensis) from the Diet of Mourning Doves (Zenaida macroura) from Southeastern New Mexico
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Emily R. Neilson, Collin S. Deen, John L. Hunt, Dixie Lozano-Lopez, Matthew E. Grilliot, Taytumn R. Schlegel-Ridgway, and Troy L. Best
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biology ,Croton texensis ,Energy density ,Zoology ,biology.organism_classification ,Zenaida macroura - Published
- 2019
8. Mammals of the Southeastern United States
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Troy L. Best, John L. Hunt, Troy L. Best, and John L. Hunt
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- Mammals--Southern States--Identification
- Abstract
First comprehensive account of the mammals of the entire southeastern US The southeastern United States is home to a remarkable and diverse mammalian fauna that is a significant part of the region's rich natural heritage. Mammals of the Southeastern United States presents accounts of 137 species that currently or previously occurred in the Southeast. Although accessible and useful for the generalist, this book provides an up-to-date compilation of basic knowledge about native and nonnative mammals of the region that is suitable for students of all ages and for professional mammalogists and biologists alike. This volume profiles common species like the eastern gray squirrel, the white-tailed deer, and the Virginia opossum, but also includes among its accounts many extant species, such as the jaguar and porcupine, that once occurred in the region; native species, like the Caribbean monk seal, that are now extinct; native species that have been extirpated, or wiped out, from all or part of the region, such as the red wolf, cougar, American bison, and elk; and many introduced species, including the Mexican mouse opossum, common squirrel monkey, and capybara. Each species account includes full-color images of the animal, plates featuring at least three views of its skull, color distribution maps of its approximate geographic range in the Southeast and in North America, and an up-to-date synthesis of several aspects of its biology, including habitat, diet, predators, parasites, diseases, and behaviors. An introductory chapter on conservation summarizes the current status of mammalian populations in the region and provides insight into some of the threats mammals now encounter in the Southeast.
- Published
- 2020
9. Organochloride Pesticides Present in Animal Fur, Soil, and Streambed in an Agricultural Region of Southeastern Arkansas
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Christopher G. Sims, John L. Hunt, and Matthew E. Grilliot
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chemistry.chemical_compound ,chemistry ,Agriculture ,business.industry ,Environmental chemistry ,Environmental science ,Chlordane ,Organochloride ,Pesticide ,Animal fur ,business ,Corynorhinus rafinesquii - Published
- 2018
10. Survey of Rodents within Arkansas Game and Fish Commission Wildlife Management Areas
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C. Renn Tumlison, M. B. Connior, Lance A. Durden, D. P. Holland, D. Blake Sasse, and John L. Hunt
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Fishery ,Geography ,%22">Fish ,Wildlife management ,Commission - Published
- 2017
11. The year in burns 2010
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Brett D. Arnoldo, Jose P. Sterling, Steven E. Wolf, and John L. Hunt
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medicine.medical_specialty ,Critical Care ,Demographics ,medicine.medical_treatment ,Nutritional Status ,English language ,Critical Care and Intensive Care Medicine ,Stress Disorders, Post-Traumatic ,Epidemiology ,medicine ,Humans ,Pain Management ,Rehabilitation ,business.industry ,Year in review ,Burn treatment ,General Medicine ,Plastic Surgery Procedures ,Surgery ,Family medicine ,Inhalation injury ,Wound Infection ,Emergency Medicine ,Burns ,business ,Topic areas ,Burns, Inhalation - Abstract
For 2010, roughly 1446 original burn research articles were published in scientific journals using the English language. This article reviews those with the most impact on burn treatment according to the Editor of one of the major journals (Burns) and his colleagues. As in previous reviews, articles were divided into the following topic areas: epidemiology, demographics of injury, wound characterisation and treatment, critical care, inhalation injury, infection, metabolism and nutrition, psychological considerations, pain and itching management, rehabilitation and long-term outcomes, and burn reconstruction. Each paper is considered very briefly, and the reader is referred to full manuscripts for details.
- Published
- 2011
12. Reproductive cycle of Baird's pocket gopher (Geomys breviceps) in northern Louisiana
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Heather E. Peek, John L. Hunt, Christopher R. Ellington, Matthew B. Connior, and Douglas C. Cagle
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Baird's pocket gopher ,biology ,Ecology ,Geomys breviceps ,Reproductive cycle ,biology.organism_classification ,Ecology, Evolution, Behavior and Systematics ,Genus Geomys - Abstract
We examined the reproductive status of Baird's pocket gophers (Geomys breviceps) in Union Parish, Louisiana, for 18 months in 2010 and 2011. We found that pocket gophers were potentially reproductively active throughout the year, although the number of reproductively active gophers peaked during late spring through autumn. Our results are similar to those of studies of Baird's pocket gopher in other states and of other pocket gophers in the genus Geomys.
- Published
- 2014
13. Vegetative Characteristics of Active and Abandoned Leks of Lesser Prairie-Chickens (Tympanuchus pallidicinctus) in Southeastern New Mexico
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John L. Hunt and Troy L. Best
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biology ,Range (biology) ,Prosopis glandulosa ,Ecology ,business.industry ,Andropogon ,Tympanuchus ,biology.organism_classification ,Geography ,Grazing ,Livestock ,Overgrazing ,Sporobolus ,business ,Ecology, Evolution, Behavior and Systematics - Abstract
Populations of lesser prairie-chickens (Tympanuchus pallidicinctus) have declined sharply across the range of the species, including southeastern New Mexico. Several possible causes for this decline have been suggested, including overgrazing by livestock. To test this hypothesis, vegetative composition of active and abandoned leks of lesser prairie-chickens and the pastures in which they were located was measured using the line-point sampling method. Vegetative composition of active leks and the pastures in which they were located was significantly different from those of abandoned leks and surrounding pastures in all 3 years of the study. Active leks and surrounding pastures had significantly more bluestem (Andropogon) and less dropseed (Sporobolus) than did abandoned leks and surrounding pastures. Abandoned leks were closer to honey mesquites (Prosopis glandulosa) >60 cm in height than were active leks. Results are symptomatic of overgrazing, which is detrimental to populations of lesser prairi...
- Published
- 2010
14. Pre–Burn Center Management of the Burned Airway: Do We Know Enough?
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John L. Hunt, Gary F. Purdue, Brett A. Arnoldo, and Alexander L. Eastman
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Adult ,Male ,Emergency Medical Services ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Burn Units ,Respiratory System ,Bronchoscopy ,Intubation, Intratracheal ,Southwestern United States ,medicine ,Humans ,Intubation ,Registries ,Child ,Emergency Treatment ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Rehabilitation ,Clinical course ,Infant ,Burn center ,Retrospective cohort study ,Length of Stay ,Middle Aged ,Surgery ,Child, Preschool ,Inhalation injury ,Emergency medicine ,Emergency Medicine ,Female ,Airway management ,Burns ,business ,Airway - Abstract
Despite the traditional teaching of early and aggressive airway management in thermally injured patients, paramedics and medical providers outside of burn centers receive little formal training in this difficult skill set. However, the initial airway management of these patients is often performed by these preburn center providers (PBCPs). The purpose of this study was to evaluate the authors' experience with patients intubated by PBCPs and subsequently managed at the authors' center. A retrospective review of a level I burn center database was undertaken. All records of patients arriving intubated were reviewed. From January 1982 to June 2005, 11,143 patients were admitted to the regional burn center; 11.4% (n = 1,272) were intubated before arrival. In this group, mean age was 37.1 years, mean burn size was 35.3% TBSA, and mean length of hospital stay was 27.0 days. Approximately 26.3% were suspected of having an inhalation injury, and this was confirmed by either bronchoscopy or clinical course in 88.6% of this subgroup. Mortality in patients arriving intubated was 30.8%, and these were excluded from the rest of the analysis. In the surviving 879 intubated patients, reasons reported by PBCPs for intubation included "airway swelling" in 34.1%, "prophylaxis" in 27.9%, and "ventilation or oxygenation needs" in 13.2%. Of these patients, 16.3% arrived directly from the scene, with the remainder arriving from another hospital facility. Of all survivors who arrived intubated, 11.9% were extubated on the day of admission, 21.3% were extubated on the first postburn day (PBD), and 8.2% were extubated on the second PBD. No patients who were extubated on PBD1 or PBD2 had to be reintubated. A significant number of burn patients have their initial airway management by PBCPs. Of these, a significant number are extubated soon after arrival at the burn center without adverse sequelae. Rationale for their initial intubation varies, but education is warranted in the prehospital community to reduce unnecessary intubation of the burn patient.
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- 2010
15. Analysis of factorial time-course microarrays with application to a clinical study of burn injury
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Baiyu, Zhou, Weihong, Xu, David, Herndon, Ronald, Tompkins, Ronald, Davis, Wenzhong, Xiao, Wing Hung, Wong, Mehmet, Toner, H Shaw, Warren, David A, Schoenfeld, Laurence, Rahme, Grace P, McDonald-Smith, Douglas, Hayden, Philip, Mason, Shawn, Fagan, Yong-Ming, Yu, J Perren, Cobb, Daniel G, Remick, John A, Mannick, James A, Lederer, Richard L, Gamelli, Geoffrey M, Silver, Michael A, West, Michael B, Shapiro, Richard, Smith, David G, Camp, Weijun, Qian, John, Storey, Michael, Mindrinos, Rob, Tibshirani, Stephen, Lowry, Steven, Calvano, Irshad, Chaudry, Mitchell, Cohen, Ernest E, Moore, Jeffrey, Johnson, Lyle L, Moldawer, Henry V, Baker, Philip A, Efron, Ulysses G J, Balis, Timothy R, Billiar, Juan B, Ochoa, Jason L, Sperry, Carol L, Miller-Graziano, Asit K, De, Paul E, Bankey, Celeste C, Finnerty, Marc G, Jeschke, Joseph P, Minei, Brett D, Arnoldo, John L, Hunt, Jureta, Horton, Bernard, Brownstein, Bradley, Freeman, Ronald V, Maier, Avery B, Nathens, Joseph, Cuschieri, Nicole, Gibran, Matthew, Klein, and Grant, O'Keefe
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Adult ,Male ,Burn injury ,Time Factors ,Microarray ,Pooling ,Bioinformatics ,Databases, Genetic ,Humans ,Medicine ,natural sciences ,Longitudinal Studies ,Child ,Oligonucleotide Array Sequence Analysis ,Analysis of Variance ,Models, Statistical ,Multidisciplinary ,Genes, Immunoglobulin ,business.industry ,Microarray analysis techniques ,Gene Expression Profiling ,Age Factors ,Infant ,Factorial experiment ,Middle Aged ,Prognosis ,Cross-Sectional Studies ,Genes, Mitochondrial ,Child, Preschool ,Data Interpretation, Statistical ,Physical Sciences ,Multiple comparisons problem ,Female ,Analysis of variance ,DNA microarray ,Burns ,business ,Software - Abstract
Time-course microarray experiments are capable of capturing dynamic gene expression profiles. It is important to study how these dynamic profiles depend on the multiple factors that characterize the experimental condition under which the time course is observed. Analytic methods are needed to simultaneously handle the time course and factorial structure in the data. We developed a method to evaluate factor effects by pooling information across the time course while accounting for multiple testing and nonnormality of the microarray data. The method effectively extracts gene-specific response features and models their dependency on the experimental factors. Both longitudinal and cross-sectional time-course data can be handled by our approach. The method was used to analyze the impact of age on the temporal gene response to burn injury in a large-scale clinical study. Our analysis reveals that 21% of the genes responsive to burn are age-specific, among which expressions of mitochondria and immunoglobulin genes are differentially perturbed in pediatric and adult patients by burn injury. These new findings in the body’s response to burn injury between children and adults support further investigations of therapeutic options targeting specific age groups. The methodology proposed here has been implemented in R package “TANOVA” and submitted to the Comprehensive R Archive Network at http://www.r-project.org/ . It is also available for download at http://gluegrant1.stanford.edu/TANOVA/ .
- Published
- 2010
16. Sustained Impairments in Cutaneous Vasodilation and Sweating in Grafted Skin Following Long-Term Recovery
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Craig G. Crandall, John L. Hunt, Brett D. Arnoldo, Scott L. Davis, David A. Low, Jian Cui, Karen J. Kowalske, Gary F. Purdue, David M. Keller, Jonathan E. Wingo, and Manabu Shibasaki
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Adult ,Male ,Nitroprusside ,Endothelium ,Microdialysis ,Sweating ,Vasodilation ,Transplantation, Autologous ,Surgical Flaps ,Article ,Body Temperature ,SWEAT ,Cutaneous vasodilation ,Laser-Doppler Flowmetry ,medicine ,Humans ,Skin ,integumentary system ,business.industry ,Rehabilitation ,Skin Transplantation ,Thermoregulation ,Acetylcholine ,medicine.anatomical_structure ,Anesthesia ,Emergency Medicine ,Female ,Surgery ,Sodium nitroprusside ,medicine.symptom ,Burns ,business ,Vasoconstriction ,Body Temperature Regulation ,medicine.drug - Abstract
We previously identified impaired cutaneous vasodilation and sweating in grafted skin 5 to 9 months postsurgery. The aim of this investigation was to test the hypothesis that cutaneous vasodilation, but not sweating, is restored as the graft heals. Skin blood flow and sweat rate were assessed from grafted skin and adjacent noninjured skin in three groups of subjects: 5 to 9 months postsurgery (n = 13), 2 to 3 years postsurgery (n = 13), and 4 to 8 years postsurgery (n = 13) during three separate protocols: 1) whole-body heating and cooling, 2) local administration of vasoactive drugs, and 3) local heating and cooling. Cutaneous vasodilation and sweating during whole-body heating were significantly lower (P < .001) in grafted skin when compared with noninjured skin across all groups and demonstrated no improvements with recovery time postsurgery. Maximal endothelial-dependent (acetylcholine) and endothelial-independent (sodium nitroprusside) cutaneous vasodilation remained attenuated (P < .001) in grafted skin up to 4 to 8 years postsurgery, indicating postsynaptic impairments. In grafted skin, cutaneous vasoconstriction during whole-body and local cooling was preserved, whereas vasodilation to local heating was impaired, regardless of the duration postsurgery. Split-thickness skin grafts have impaired cutaneous vasodilation and sweating up to 4 to 8 years postsurgery, thereby limiting the capability of this skin’s contribution to thermoregulation during a heats stress. In contrast, grafted skin has preserved vasoconstrictor capacity.
- Published
- 2009
17. Epistatic Interactions are Critical to Gene-Association Studies: PAI-1 and Risk for Mortality After Burn Injury
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Gary F. Purdue, Robert Barber, Agnes Burris, Ling Yu E. Chang, Susan M. Lemaire, John L. Hunt, Jureta W. Horton, and Brett D. Arnoldo
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Adult ,Male ,Oncology ,medicine.medical_specialty ,Genotype ,Single-nucleotide polymorphism ,Infections ,Logistic regression ,Polymorphism, Single Nucleotide ,Risk Assessment ,Risk Factors ,Internal medicine ,Epidemiology ,medicine ,Humans ,SNP ,Prospective Studies ,Risk factor ,Genetic association ,business.industry ,Rehabilitation ,Confounding ,Epistasis, Genetic ,Biolistics ,Middle Aged ,Surgery ,Phenotype ,Emergency Medicine ,Wounds and Injuries ,Injury Severity Score ,Female ,Burns ,business - Abstract
Replication of statistically significant associations between single nucleotide polymorphisms (SNPs) and disease phenotypes has been problematic. One reason for conflicting observations may be failure to consider confounding factors, including gene-gene (epistatic) interactions. Our experience with the insertion/deletion polymorphism at -688 in the promoter region of plasminogen activator inhibitor (PAI-1) seems to support this contention and may foreshadow problems for genome-wide association scans, which tend to use unadjusted analytical methodologies. One hundred forty-nine patients withor =15% total body surface area (TBSA) burns, without significant nonburn-related trauma (injury severity scoreor =16), traumatic or anoxic brain injury or spinal cord injury who survived48 hours postadmission were enrolled under a protocol approved by the UT Southwestern and Parkland Hospital IRBs. Clinical data were collected prospectively and candidate polymorphisms in PAI-1 (-688), toll-like receptor 4 (+896), CD14 (-159), tumor necrosis factor-alpha (-308), and interleukin-6 (-174) were genotyped. The PAI-1 SNP was significantly associated (P-value for trend = 0.036) with risk for death when evaluated in isolation by unadjusted analysis. However, after adjustment for potential confounders using multiple logistic regression, only age, full-thickness burn size, and CD14 genotype (as previously reported) were associated with increased mortality. Genetic association analyses should be adjusted for interactions between multiple SNPs, injury or disease characteristics, and demographic variables. Increasingly sophisticated analytical methods will be required as gene-mapping studies transition from a candidate-gene based approach to genome-wide association scans.
- Published
- 2008
18. Impaired Cutaneous Vasodilation and Sweating in Grafted Skin During Whole-Body Heating
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Gary F. Purdue, Jian Cui, Manabu Shibasaki, Craig G. Crandall, David A. Low, John L. Hunt, Scott L. Davis, Karen J. Kowalske, David M. Keller, and T Brett D Arnoldo
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Adult ,Male ,medicine.medical_specialty ,Mean arterial pressure ,medicine.medical_treatment ,Arbitrary unit ,Sweating ,Vasodilation ,Skin Diseases ,Transplantation, Autologous ,Article ,Body Temperature ,SWEAT ,Heart Rate ,Internal medicine ,Heart rate ,Cutaneous vasodilation ,Humans ,Medicine ,Prospective Studies ,integumentary system ,business.industry ,Rehabilitation ,Skin Transplantation ,Transplantation ,Endocrinology ,Anesthesia ,Emergency Medicine ,Skin grafting ,Female ,Surgery ,Burns ,business ,Body Temperature Regulation - Abstract
The aim of this investigation was to identify the consequences of skin grafting on cutaneous vasodilation and sweating in split-thickness grafted skin during indirect whole-body heating 5 to 9 months after surgery. In addition, thermoregulatory function was examined at donor skin sites on a separate day. Skin blood flow and sweat rate (SR) were assessed from both grafted (n = 14) or donor skin (n = 11) and compared with the respective adjacent control skin during indirect whole-body heating. Cutaneous vascular conductance (CVC) was calculated from the ratio of skin blood flow (arbitrary units; au) to mean arterial pressure. Whole-body heating significantly increased internal temperature (37.0 +/- 0.1 degrees C to 37.8 +/- 0.1 degrees C; P < .05). Cutaneous vasodilation (ie, the increase in CVC from baseline, deltaCVC) during whole-body heating was significantly attenuated in grafted skin (deltaCVC = 0.14 +/- 0.15 au/mm Hg) compared with adjacent control skin (deltaCVC = 0.84 +/- 0.11 au/mm Hg; P < .05). Increases in sweat rate (deltaSR) were also significantly lower in grafted skin (deltaSR = 0.08 +/- 0.08 mg/cm2/min) compared with adjacent control skin (deltaSR = 1.16 +/- 0.20 mg/ cm2/min; P < .05). Cutaneous vasodilation and sweating during heating were not significantly different between donor sites (deltaCVC = 0.71 +/- 0.19 au/mm Hg; deltaSR = 1.04 +/- 0.15 mg/cm2/min) and adjacent control skin (deltaCVC = 0.50 +/- 0.10 au/mm Hg; deltaSR = 0.83 +/- 0.17 mg/cm2/min). Greatly attenuated or absence of cutaneous vasodilation and sweating suggests impairment of thermoregulatory function in grafted skin, thereby, diminishing the contribution of this skin to overall temperature control during a heat stress.
- Published
- 2007
19. Use of High-Frequency Percussive Ventilation in Inhalation Injuries
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Gary F. Purdue, Jason J. Hall, John L. Hunt, and Brett D. Arnoldo
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Adult ,Male ,Smoke Inhalation Injury ,medicine.medical_treatment ,High-Frequency Ventilation ,law.invention ,law ,Humans ,Medicine ,Retrospective Studies ,Mechanical ventilation ,Inhalation ,Thermal injury ,business.industry ,Rehabilitation ,High-frequency ventilation ,Pneumonia ,medicine.disease ,Intensive care unit ,Barotrauma ,Anesthesia ,Emergency Medicine ,Breathing ,Female ,Surgery ,Burns ,business - Abstract
Inhalation injury causes significant morbidity and mortality, accounting for nearly 80% of non-fire-related deaths and affecting nearly 25% of all patients hospitalized with thermal injury. High-frequency percussive ventilation (HFPV) has been reported to decrease both the incidence of pulmonary barotrauma and pneumonia in inhalation injury. It has evolved into a ventilatory modality promoted to rapidly remove airway secretions and improve survival of patients with smoke inhalation injury. From 1997 to 2005, a total of 92 patients with inhalation injury were treated with HFPV. This group was compared with 130 patients treated with conventional mechanical ventilation between 1997 and 2005. The diagnosis of inhalation injury was made on admission, based on the following clinical criteria: injury in a closed space, carbonaceous sputum, and/or positive bronchoscopy (presence of carbonaceous deposits, erythema or ulceration). Both modes of ventilation were begun within 24 hours of injury. Both groups were similar with respect to demographics and injury severity. The mean number of ventilator days, days in the intensive care unit, length of stay, and incidence of pneumonia did not differ significantly between groups. Twenty-six of 92 (28%) patients treated with HFPV, and 56 of 130 with conventional mechanical ventilation (43%) died. There was a significant decrease in both overall morbidity and mortality in the subset of patients with < or = 40% TBSA treated with HFPV. Future randomized, controlled trials are needed to determine the precise role of HFPV in the treatment of inhalation injuries.
- Published
- 2007
20. CD14−159 C ALLELE IS ASSOCIATED WITH INCREASED RISK OF MORTALITY AFTER BURN INJURY
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Robert Barber, Ling Yu E. Chang, John L. Hunt, Gary F. Purdue, Jureta W. Horton, Brett D. Arnoldo, and Corinne Aragaki
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Adult ,Male ,Risk ,medicine.medical_specialty ,Burn injury ,Time Factors ,Critical Care ,Genotype ,Smoke Inhalation Injury ,Lipopolysaccharide Receptors ,Single-nucleotide polymorphism ,Critical Care and Intensive Care Medicine ,Polymorphism, Single Nucleotide ,Gastroenterology ,Risk Factors ,Internal medicine ,medicine ,Genetic predisposition ,Humans ,Spinal cord injury ,Alleles ,Polymorphism, Genetic ,business.industry ,Odds ratio ,Middle Aged ,medicine.disease ,Multivariate Analysis ,Emergency Medicine ,Injury Severity Score ,Female ,Burns ,business ,Total body surface area - Abstract
Although comprehension of postburn pathophysiology has grown in recent years, we are still unable to accurately identify burn patients who are at an increased risk of infectious complications and death. This unexplained variation is likely influenced by heritable factors; the genetic predisposition for death from infection has been estimated as greater than that for cardiovascular disease or cancer. Identify genetic variants associated with increased mortality after burn injury. A total of 233 patients with burns of 15% of total body surface area or greater or smoke inhalation injury who survived more than 48 h after admission and were without significant nonburn-related trauma (injury severity score > or = 16), traumatic or anoxic brain injury, or spinal cord injury. We examined the influence of genotype at five candidate loci (interleukin [IL]-1beta, IL-6, tumor necrosis factor-alpha, toll-like receptor 4, CD14) on mortality risk after burn injury. DNA was isolated from residual blood from laboratory draws and candidate genotypes were determined by real-time polymerase chain reaction using TaqMan probes. Clinical data were prospectively collected into a local, curated database. Allelic associations were analyzed by multivariate logistic regression. After adjustment for age, full-thickness burn size, inhalation injury, ethnicity, and sex, carriage of the CD14-159 C allele imparted at least a 1.3-fold increased risk for death after burn injury, relative to TT homozygotes (adjusted odds ratio, 2.9; 95% confidence interval, 1.3-6.8; P = 0.01). This association was stronger (adjusted odds ratio, 3.3; 95% confidence interval, 1.3-8.4; P = 0.01) when the analysis was conducted only on deaths accompanied by severe sepsis. In addition, a gene dosage effect for increased mortality was apparent for carriage of the CD14-159 C allele (P = 0.006). The gene dosage effect remained when white, Hispanic, or African American patients were analyzed independently, although statistical significance was not achieved in the subgroup analysis. None of the other single nucleotide polymorphisms examined were significantly associated with mortality. These data provide strong evidence that a CD14 promoter allele that is known to impart lower baseline and induced CD14 transcription also affects mortality risk after burn injury. A potential (although untested) mechanism for our observation is that reduced signaling through CD14/toll-like receptor 4 in response to challenge by gram-negative bacteria after burns results in a blunted innate immune response and subsequent increased likelihood for systemic infection and death.
- Published
- 2007
21. Dr Frederick Knight Hunt (1814–54) re-visited: medical man and journalist
- Author
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John L Hunt
- Subjects
Publishing ,History ,Notice ,Newspapers as Topic ,Medicine (miscellaneous) ,History, 19th Century ,Journalism, Medical ,Newspaper ,England ,History and Philosophy of Science ,Social Justice ,Knight ,Humans ,Classics - Abstract
This paper studies Knight Hunt's career after he lost control of the Medical Times, and shows how he was brought to the notice of Charles Dickens who made him a sub-editor on the Daily News in 1845 and subsequently selected him as a pivotal contributor to Household Words, a post he gave up only when he became editor of the newspaper in 1851.
- Published
- 2006
22. Inflammation and the Host Response to Injury: An Overview of the Multicenter Study of the Genomic and Proteomic Response to Burn Injury
- Author
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Geoff Silver, Matthew B. Klein, Richard L. Gamelli, John L. Hunt, Ronald G. Tompkins, Nicole S. Gibran, and David N. Herndon
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Proteomics ,Pathology ,medicine.medical_specialty ,Burn injury ,Host response ,Poison control ,Genomics ,Inflammation ,Bioinformatics ,Injury response ,Cohort Studies ,Injury prevention ,medicine ,Humans ,Multicenter Studies as Topic ,business.industry ,Rehabilitation ,Multicenter study ,Research Design ,Emergency Medicine ,Surgery ,medicine.symptom ,Burns ,business - Abstract
Inflammation and the Host Response to Injury is a prospective, multicenter, federally funded collaborative study of the genomic and proteomic basis for injury response. This study has brought together clinical specialists in burn injury with experts in genomics, proteomics, and bioinformatics to answer questions related to immunoinflammatory responses to injury. The purpose of this report is to describe the structure, organization, goals, and current progress of this Glue Grant project.
- Published
- 2006
23. Quantitative Proteome Analysis of Human Plasma following in Vivo Lipopolysaccharide Administration Using 16O/18O Labeling and the Accurate Mass and Time Tag Approach
- Author
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Tao Liu, Irshad H. Chaudry, Brad Freeman, Ronald G. Tompkins, Mehmet Toner, Carol L. Miller-Graziano, David G. Camp, F. A. Moore, Paul E. Bankey, Avery B. Nathens, Timothy R. Billiar, John L. Hunt, Henry V. Baker, Krzystof Laudanski, Daniel G. Remick, J. Perren Cobb, Gordon A. Anderson, Jeffrey L. Johnson, Brian G. Harbrecht, Michael N. Mindrinos, Michael B. Shapiro, Laurence G. Rahme, Vernon R. Young, Ronald V. Maier, David A. Schoenfeld, Joseph P. Minei, Bernard H. Brownstein, Richard D. Smith, Robert L. Sheridan, Geoffrey M. Silver, Lyle L. Moldawer, Wei-Jun Qian, Ronald W. Davis, Wenzhong Xiao, Ernest E. Moore, Adrian Fay, Doug Hayden, H. Shaw Warren, Richard L. Gamelli, Stephen F. Lowry, James A. Lederer, Grant E. O'Keefe, John A. Mannick, David N. Herndon, Yufeng Shen, Rui Zhang, Nicole S. Gibran, Robert J. Feezor, Tanya Logvinenko, Bruce A. McKinley, Martin L. Yarmush, Ronald J. Moore, Matthew E. Monroe, Jureta W. Horton, Michael West, Steven E. Wolf, David J. Anderson, Steve E. Calvano, Jon M. Jacobs, and Scott Somers
- Subjects
Lipopolysaccharides ,Spectrometry, Mass, Electrospray Ionization ,Time Factors ,Proteome ,Lipopolysaccharide ,Peptide ,Oxygen Isotopes ,Mass spectrometry ,Peptide Mapping ,Biochemistry ,Article ,Analytical Chemistry ,chemistry.chemical_compound ,In vivo ,Blood plasma ,Humans ,Molecular Biology ,chemistry.chemical_classification ,Chromatography ,Fourier Analysis ,Blood Proteins ,Chromatography, Ion Exchange ,Blood proteins ,Oxygen ,chemistry ,Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ,Quantitative analysis (chemistry) ,Chromatography, Liquid - Abstract
Identification of novel diagnostic or therapeutic biomarkers from human blood plasma would benefit significantly from quantitative measurements of the proteome constituents over a range of physiological conditions. Herein we describe an initial demonstration of proteome-wide quantitative analysis of human plasma. The approach utilizes post-digestion trypsin-catalyzed 16O/18O peptide labeling, two-dimensional liquid chromatography (LC)-Fourier transform ion cyclotron resonance ((FTICR) mass spectrometry, and the accurate mass and time (AMT) tag strategy to identify and quantify peptides/proteins from complex samples. A peptide accurate mass and LC-elution time AMT tag database was initially generated using tandem mass spectrometry (MS/MS) following extensive multidimensional LC separations to provide the basis for subsequent peptide identifications. The AMT tag database contains >8,000 putative identified peptides, providing 938 confident plasma protein identifications. The quantitative approach was applied without depletion for high abundant proteins for comparative analyses of plasma samples from an individual prior to and 9 h after lipopolysaccharide (LPS) administration. Accurate quantification of changes in protein abundance was demonstrated by both 1:1 labeling of control plasma and the comparison between the plasma samples following LPS administration. A total of 429 distinct plasma proteins were quantified from the comparative analyses and the protein abundances for 25 proteins, including several known inflammatory response mediators, were observed to change significantly following LPS administration.
- Published
- 2005
24. Electrical Injuries: A 20-Year Review
- Author
-
Brett D. Arnoldo, Agnes Burris, John L. Hunt, Gary F. Purdue, Phala A. Helm, and Karen J. Kowalske
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Burn Units ,Poison control ,Suicide prevention ,Occupational safety and health ,Electrical Injuries ,Patient Admission ,Injury prevention ,Accidents, Occupational ,Humans ,Medicine ,Electric injury ,Registries ,Sex Distribution ,Child ,General Nursing ,Aged ,Aged, 80 and over ,business.industry ,Rehabilitation ,Human factors and ergonomics ,Length of Stay ,Middle Aged ,medicine.disease ,Texas ,Electric Injuries ,General Health Professions ,Emergency medicine ,Emergency Medicine ,Female ,Surgery ,Medical emergency ,business ,Lightning injuries - Abstract
Electrical injuries continue to present problems with devastating complications and long-term socioeconomic impact. The purpose of this study is to review one institution's experience with electrical injuries. From 1982 to 2002, there were 700 electric injury admissions. A computerized burn registry was used for data collection and analysis. Of these injuries, 263 were high voltage (≥1000 V), 143 were low voltage (
- Published
- 2004
25. Sentinel Lymph Node Biopsy Identifies Occult Nodal Metastases in Patients with Marjolin's Ulcer
- Author
-
Guy Lindberg, Jason B. Fleming, Gary F. Purdue, Alexander L. Eastman, John L. Hunt, and W. A. Erdman
- Subjects
Male ,medicine.medical_specialty ,Skin Neoplasms ,Sentinel lymph node ,Isosulfan Blue ,Biopsy ,medicine ,Carcinoma ,Humans ,Prospective Studies ,Prospective cohort study ,General Nursing ,Gamma counter ,medicine.diagnostic_test ,Sentinel Lymph Node Biopsy ,business.industry ,Rehabilitation ,Marjolin's ulcer ,Middle Aged ,medicine.disease ,Occult ,Surgery ,Cell Transformation, Neoplastic ,Lymphatic Metastasis ,General Health Professions ,Carcinoma, Squamous Cell ,Emergency Medicine ,Lymph Nodes ,Radiology ,Neoplasm Recurrence, Local ,Burns ,business - Abstract
Since Marjolin's description, the management of burn scar carcinoma has remained controversial. A multitude of options and recommendations exist for the management of both primary lesions and regional nodal metastasis. This work reviews six cases of Marjolin's ulcer staged using sentinel lymph node biopsy. All primary lesions were confirmed to be squamous cell carcinoma and occurred a median of 29.5 years after burn. No patient had clinically detectable lymphadenopathy. In all cases, preoperative lymphoscintigraphy successfully identified a single draining regional nodal basin. Subsequent intraoperative lymphatic mapping/sentinel lymph node (SLN) biopsy was successful in five of six cases (83%). A successful intraoperative lymphatic mapping/SLN biopsy was defined as the identification of blue (uptake of isosulfan blue dye) or “hot” (uptake of radiolabeled sulfur colloid as measured with a handheld gamma counter) node(s) and subsequent excision. Four of five SLN biopsies identified previously occult nodal metastasis. SLN biopsy represents a minimally invasive and accurate staging procedure for Marjolin's ulcer.
- Published
- 2004
26. On the use of spleen mass as a measure of avian immune system strength
- Author
-
John L. Hunt and Kevin G. Smith
- Subjects
Biometry ,Avian immune system ,Spleen ,Disease ,Models, Theoretical ,Biology ,Host-Parasite Interactions ,Birds ,medicine.anatomical_structure ,Immune system ,Evolutionary biology ,Immune System ,Immunology ,medicine ,Large spleen ,Animals ,Positive relationship ,Evolutionary ecology ,Immunocompetence ,Ecology, Evolution, Behavior and Systematics - Abstract
The avian spleen has been frequently used in studies of avian ecology, parasitology, and evolution to infer immune system strength in birds. Traditionally, it has been assumed that a large spleen is representative of a strong immune system and conclusions based on this assumption have led to interesting interpretations of the role of disease and parasitism, for example in predator-prey interactions. This assumption of a positive relationship between spleen size and immune system strength has been made despite an incomplete understanding of the physiology of the avian spleen and little evidence of the validity of such an assumption. In this response, we demonstrate that the assumption of a predictable, positive relationship between spleen size and immunocompetence may be unjustified based on what is known of avian splenology. We also review recent research that may indicate that the inverse of the above assumption is true and we discuss general limitations of the use of the spleen as an indicator of immune system strength in birds. Finally, we make recommendations for future research topics in this field of study.
- Published
- 2004
27. Eumops bonariensis
- Author
-
John L. Hunt, Lisa A. McWilliams, Troy L. Best, and Kevin G. Smith
- Subjects
Animal Science and Zoology ,Ecology, Evolution, Behavior and Systematics - Published
- 2003
28. Burns and Trauma
- Author
-
John L. Hunt and Gary F. Purdue
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,medicine ,Surgery ,business - Published
- 2003
29. The Resident Experience on Trauma: Declining Surgical Opportunities and Career Incentives? Analysis of Data from a Large Multi-institutional Study
- Author
-
Ajai K. Malhotra, Antoinette Kanne, Lawrence Lottenberg, Michael F. Rotondo, Richard A. Pomerantz, Andrew B. Peitzman, Scott G. Sagraves, Pascal Udekwu, Juan L. Peschiera, Jennifer L. Sarafin, David J. Dries, Thomas M. Scalea, Gary W. Welch, Kwang I. Suh, Juan A. Asensio, Michael Oswanshi, Farouck N. Obeid, Ronald G. Albuquerque, Victor L. Landry, Hans Joseph Schmidt, Deborah Baker, Dorraine D. Watts, Raymond Talucci, Scott B. Frame, John B. Holcomb, Lewis J. Kaplan, Dennis Wang, S. M. Siram, Grace S. Rozycki, Russell Dumire, Benjamin D. Mosher, Eliza Enriquez, Terrence H. Liu, Samir M. Fakhry, Anne Kuzas, F.Barry Knotts, Sherry M. Melton, John F. Bilello, George M. Testerman, Blaine L. Enderson, James S. Gregory, Dennis W. Ashley, Patrick A. Dietz, Karlene E. Sinclair, Diane Higgins, Ivan Puente, Barbara Esposito, Stuart J.D. Chow, William F. Pfeifer, Daniel C. Cullinane, Judith Phillips, James K. Lukan, Michael Moncure, John L. Hunt, John R. Hall, Susan Schrage, Pauline Park, Faran Bokhari, Jeffery Rosen, Kathleen A. LaVorgna, Gerard J. Fulda, Monica Newton, Macram M. Ayoub, Leanne Adams, Mark L. Gestring, Thomas A. Santora, Paul R. Kemmeter, Joan L. Huffman, William Marx, Mitchell S. Farber, Karyn L. Butler, Collin E.M. Brathwaite, Jon Walsh, Jeffrey P. Salomone, John D. Josephs, Timothy C. Fabian, Frederick A. Moore, Murray J. Cohen, Paul E. Bankey, Wayne E. Vander Kolk, Dan A. Galvan, John Bonadies, Walter Forno, James M. Cross, Nirav Patel, Pam Nichols, Carnell Cooper, Michael Haraschak, Judith A. O'connor, Daniel Powers, Mary B. Myers, Kathleen P. O’hara, A. Jay Raimonde, Hani Seoudi, Juan B. Grau, Imtiaz A. Munshi, Kimberly K. Nagy, Peter Rhee, Eddy H. Carrillo, Sharon Buchro, Mary Jo Wright, Lisa A. Patterson, Dennis B. Dove, C. M. Buechler, Wendy L. Wahl, Wendy Sue Shreve, Thomas H. Cogbill, Robert A. Cherry, Scott H. Norwood, J. Martin Perez, Bernard R. Boulanger, J. P. Dineen, John E. Sutton, Arthur B. Dalton, Scott Monk, Carl P. Valenziano, Christopher D. Wohltmann, Michael Schurr, Robert A. Jubelelirer, William J. Mileski, Tiffany K. Bee, Kathy Coon, Fred A. Luchette, April Settell, Arthur L. Ney, Jonathan Kohn, Mary E. Fallat, Sheila Staib, Dennis C. Gore, Van L. Vallina, Jose A. Acosta, David Kam, Jeff Strickler, Eileen Corcoran, Leon H. Pachter, Anne O'Neill, Lonnie W. Frei, Larry M. Jones, David G. Jacobs, Om P. Sharma, Curt S. Koontz, Christopher P. Michetti, Michael D. Pasquale, Raymond P. Bynoe, Pablo Rodriguez, Robert Marburger, Michael C. Chang, Karla S. Ahrns, Michael D. McGonigal, Paula Griner, Gustavo Roldán, Leonard J. Weireter, Sharon S. Cohen, Andrew J. Kerwin, L. F. Diamelio, Mauricio Lynn, Donald H. Jenkins, John P. Hunt, W. Michael Johnson, Robert Holtzman, Brian J. Daley, Paul Dabrowski, Jeffrey J. Morken, Vicki J. Bennett-Shipman, Stanley Kurek, Charles J. Yowler, Christopher Salvino, Dale Oller, Brian J. Norkiewicz, Vicki Hardwick-Barnes, Don Fishman, Frederic J. Cole, John C. Layke, Frederick B. Rogers, James Davis, Keith D. Clancy, Emily M. Sposato, Judith Johnson, Charles E. Wiles, Uretz J. Oliphant, and James V. Yuschak
- Subjects
medicine.medical_specialty ,Attitude of Health Personnel ,medicine.medical_treatment ,Specialty ,Traumatology ,Critical Care and Intensive Care Medicine ,Patient Admission ,Diagnostic peritoneal lavage ,Blunt ,Trauma Centers ,Surveys and Questionnaires ,Laparotomy ,medicine ,Humans ,Focused assessment with sonography for trauma ,Peritoneal Lavage ,Ultrasonography ,Motivation ,Career Choice ,medicine.diagnostic_test ,business.industry ,General surgery ,Trauma center ,Internship and Residency ,United States ,Education, Medical, Graduate ,Blunt trauma ,Case-Control Studies ,Workforce ,Physical therapy ,Wounds and Injuries ,Surgery ,Clinical Competence ,business - Abstract
Purpose: The surgical resident experience with trauma has changed. Many residents are exposed to predominantly nonoperative patient care experiences while on trauma rotations. Data from a large multicenter study were analyzed to estimate surgical resident exposure to trauma laparotomy, diagnostic peritoneal lavage (DPL), and focused abdominal sonography for trauma (U/S). Methods: Centers completed a self-report questionnaire on their institutional demographics, admissions, and procedure for a 2-year period (1998-1999). Results: A total of 82 trauma centers that provide resident teaching were included. The included centers represent over 247,000 trauma admissions. The majority of trauma centers (65.9%) had > 80% blunt injury. Although all centers performed laparotomies, other results were more variable. For U/S, 24.2% performed none at all and 47.0% performed fewer than two U/S examinations per month. For DPLs, 3.8% performed none and 66.7% performed fewer than two per month. Assuming 1 night of 4 on call, the average surgical resident training at a trauma center performing > 80% blunt trauma has the potential to participate in only 15 trauma laparotomies, 6 diagnostic peritoneal lavages, and 45 ultrasound examinations per year. In addition, the resident will care for an average of 500 blunt trauma patients before performing a splenectomy or liver repair. Conclusion: Surgical resident experience on most trauma services is heavily weighted to nonoperative management, with a relatively low number of procedures, little experience with DPL, and highly variable experience with ultrasound. These data have serious implications for resident training and recruitment into the specialty.
- Published
- 2003
30. Linezolid versus Vancomycin for the Treatment of Methicillin‐ResistantStaphylococcus aureusInfections
- Author
-
Donald H. Batts, Barry Hafkin, Dennis L. Stevens, Daniel Herr, John L. Hunt, and Harry Lampiris
- Subjects
Male ,Microbiology (medical) ,Staphylococcus aureus ,medicine.medical_specialty ,medicine.drug_class ,Antibiotics ,medicine.disease_cause ,chemistry.chemical_compound ,Vancomycin ,Internal medicine ,Acetamides ,medicine ,Humans ,Oxazolidinones ,Antibacterial agent ,business.industry ,Linezolid ,Middle Aged ,Staphylococcal Infections ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,medicine.disease ,Methicillin-resistant Staphylococcus aureus ,Anti-Bacterial Agents ,Surgery ,Pneumonia ,Treatment Outcome ,Infectious Diseases ,chemistry ,Bacteremia ,Female ,Methicillin Resistance ,business ,medicine.drug - Abstract
Linezolid, the first available member of a new antibiotic class, the oxazolidinones, is broadly active against gram-positive bacteria, including drug-resistant strains. In this randomized, open-label trial, hospitalized adults with known or suspected methicillin-resistant Staphylococcus aureus (MRSA) infections were treated with linezolid (600 mg twice daily; n = 240) or vancomycin (1 g twice daily; n = 220) for 7-28 days. S. aureus was isolated from 53% of patients; 93% of these isolates were MRSA. Skin and soft-tissue infection was the most common diagnosis, followed by pneumonia and urinary tract infection. At the test-of-cure visit (15-21 days after the end of therapy), among evaluable patients with MRSA, there was no statistical difference between the 2 treatment groups with respect to clinical cure rates (73.2% of patients in the linezolid group and 73.1% in the vancomycin group) or microbiological success rates (58.9% in the linezolid group and 63.2% in the vancomycin group). Both regimens were well tolerated, with similar rates of adverse events.
- Published
- 2002
31. Pediatric burn care
- Author
-
John L. Hunt, Agnes Burris, and Gary F. Purdue
- Subjects
Resuscitation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Pediatrics, Perinatology and Child Health ,Emergency Medicine ,Vascular access ,medicine ,Airway management ,Pediatric burn ,business ,Intensive care medicine - Abstract
One third of patients with significant burn injuries are children who are injured in what are nearly always preventable incidents. These extremely painful and often scarring bunts are enormous stressors to patients and their families. Children are easily devastated by the burst injury and are often less able to respond to it than au adult. Pediatric burn injury provides multiple problems in early diagnosis and management. Although the entire cutaneous injury is easily visualized severity is frequently underestimated by caregivers and by the patient's family. Management pitfalls in children will be discussed including correct estimation of horn size and depth, fluid resuscitation and fluid maintenance vascular access, airway management, and thermal homeostasis.
- Published
- 2002
32. DIFFERENTIAL ACTIVATION OF CORONARY AND PULMONARY ENDOTHELIAL CELLS BY THERMAL INJURY
- Author
-
John L. Hunt, Joseph T. Murphy, Steven Duffy, and Gary F. Purdue
- Subjects
Adult ,medicine.medical_specialty ,Burn injury ,Pathology ,Cell Membrane Permeability ,Endothelium ,Cell Survival ,Vasodilator Agents ,Pulmonary insufficiency ,Vasodilation ,Nitric Oxide ,Critical Care and Intensive Care Medicine ,Dinoprostone ,Internal medicine ,Humans ,Medicine ,Cells, Cultured ,Lung ,Endothelin-1 ,Thermal injury ,business.industry ,Intercellular Adhesion Molecule-1 ,medicine.disease ,Epoprostenol ,Pathophysiology ,Endothelial stem cell ,Endocrinology ,medicine.anatomical_structure ,Organ Specificity ,Emergency Medicine ,Endothelium, Vascular ,Burns ,business - Abstract
Remote organ dysfunction during resuscitation of severe thermal injury is characterized by early, transient pulmonary insufficiency and cardiac contractile dysfunction. Thermal injury is typified by profound systemic alterations of endothelial immunological, vasoactive, and barrier functions. The unique location of this ubiquitous, fragile monolayer makes it vulnerable to circulating serum factors created at remote cutaneous wounds. We examined endothelial "activation" in 2 distinct cell types, human coronary and pulmonary endothelial cells (EC), after severe thermal injury. By using human serum isolated at specific times after thermal injury ("early" [2 h post-burn] or "late" [26 h post-burn]), the endothelial release of vasoactive mediators, ICAM-1 expression, and monolayer permeability were assessed in vitro. Early burn serum enhanced coronary EC vasoconstrictor (ET-1) release and ICAM expression, inhibited vasodilator (PGI2) release, but had no effect on permeability. Conversely, under similar conditions, pulmonary EC PGI2 release and permeability were enhanced, ET-1 release was diminished, but ICAM was unaffected. Late burn serum enhanced vasodilator (NO) release and permeability to albumin in both coronary and pulmonary EC, whereas ET-1 release was inhibited. Under these conditions, only pulmonary ICAM expression was significantly enhanced. These data suggest that human endothelium isolated from divergent vascular beds are activated by burn injury in a unique manner for time post-burn and vascular site of cell origin.
- Published
- 2001
33. An Evaluation of Risk Factors for Mortality After Burn Trauma and The Identification of Gender-Dependent Differences in Outcomes
- Author
-
Grant E. O'Keefe, John L. Hunt, and Gary F. Purdue
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Poison control ,Logistic regression ,Occupational safety and health ,Cohort Studies ,Sex Factors ,Risk Factors ,Outcome Assessment, Health Care ,Injury prevention ,medicine ,Risk of mortality ,Humans ,Child ,Intensive care medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Models, Statistical ,business.industry ,Middle Aged ,Survival Rate ,Logistic Models ,ROC Curve ,Cohort ,Emergency medicine ,Female ,Surgery ,Burns ,business ,Total body surface area ,Burns, Inhalation ,Cohort study - Abstract
The primary objective of this study was to determine an objective method for estimating the risk of mortality after burn trauma, and secondarily, to evaluate the relationship between gender and mortality, in the setting of a quantifiable inflammatory stimulus. Previously reported estimates of mortality risk after burn trauma may no longer be applicable, given the overall reduction in case-fatality rates after burn trauma. We expect that future advances in burn trauma research will require careful and ongoing quantification of mortality risk factors to measure the importance of newly identified factors and to determine the impact of new therapies. Conflicting clinical reports regarding the impact of gender on survival after sepsis and critical illness may in part, be from different study designs, patient samples, or failure to adequately control for additional factors contributing to the development ofsepsis and mortality.Data from the prospectively maintained burn registry for patients admitted to the Parkland Memorial Hospital burn unit between January 1, 1989 and December 31, 1998 were analyzed. Logistic regression was used to generate estimates of the probability of death in half of the study sample, and this model was validated on the second half of the sample. Risk factors evaluated for their relationship with mortality were: age, inhalation injury, burn size, body mass (weight), preexisting medical conditions, nonburn injuries, and gender.Of 4,927 patients, 5.3% died. The best model for estimating mortality included the percent of total body surface area burned; the percent of full-thickness burn size; the presence of an inhalation injury; age categories of:30 years, 30 to 59 years,or = 60 years; and gender. The risk of death was approximately two-fold higher in women aged 30 to 59 years compared with men of the same age.We have provided a detailed method for estimating the risk of mortality after burn trauma, based on a large, contemporary cohort of patients. These estimates were validated on a second sample and proved to predict mortality accurately. We have identified an increased mortality risk in women of 30 to 59 years of age.
- Published
- 2001
34. THE 2000 PRESIDENTIAL ADDRESS
- Author
-
John L. Hunt
- Subjects
Gerontology ,Medical education ,medicine.medical_specialty ,business.industry ,Public health ,Rehabilitation ,Health promotion ,Presidential address ,General Health Professions ,Emergency Medicine ,medicine ,Surgery ,business ,General Nursing - Published
- 2000
35. Introduction
- Author
-
John L. Hunt
- Subjects
General Health Professions ,Rehabilitation ,Emergency Medicine ,Surgery ,General Nursing - Published
- 1999
36. Treatment of Femur Fracture with Associated Head Injury
- Author
-
David P. Chason, Joan Walker, Adam J. Starr, Charles M. Reinert, and John L. Hunt
- Subjects
Adult ,Lung Diseases ,medicine.medical_specialty ,Time Factors ,Adolescent ,Central Nervous System Diseases ,Head Injuries, Closed ,medicine ,Humans ,Glasgow Coma Scale ,Orthopedics and Sports Medicine ,Femur ,Retrospective Studies ,Femur fracture ,Multiple Trauma ,business.industry ,Head injury ,Pulmonary Complication ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Orthopedic surgery ,business ,Complication ,Femoral Fractures - Abstract
Objectives: The aim of this study was to determine (a) whether delay in femur fracture stabilization beyond twenty-four hours in patients with head injury increased the risk of pulmonary complications and (b) whether immediate (up to twenty-four hours) femur fracture stabilization increased the risk of central nervous system (CNS) complications. Design: Retrospective analysis. Materials and Methods: Thirty-two patients with femur fracture and head injury were identified. Fourteen underwent immediate stabilization of their fractures, and eighteen underwent delayed (fourteen patients) or no (four patients) stabilization of their fractures. Results: In the immediate stabilization group, five patients had severe head injuries [Glasgow Coma Score (GCS) ≤ 8] and nine had mild head injuries (GCS > 8). In the mild head injury group, no patient had a pulmonary complication and one had a CNS complication. In the severely head-injured group, one patient had a pulmonary complication and no patient had a CNS complication. In the delayed stabilization group, six patients had mild head injuries (GCS > 8) and twelve had severe head injuries (GCS ≤ 8). In the mildly head injured group, one patient had a pulmonary complication, two patients had CNS complications, and one patient died. In the severely head injured group, nine patients had pulmonary complications, three patients had CNS complications, and one patient died. Logistic regression identified delay in femur stabilization as the strongest predictor of pulmonary complication (p = 0.0042), followed by severity of chest Abbreviated Injury Score (AIS; p = 0.0057) and head AIS (p = 0.0133). Delaying fracture stabilization made pulmonary complications forty-five times more likely. Each point increase in the chest AIS and head/neck AIS increased the risk of pulmonary complication by 300 percent and 500 percent, respectively. A statistically significant predictor of CNS complications could not be identified by using logistic regression. Conclusion: Delay in stabilization of femur fracture in head-injured patients appears to increase the risk of pulmonary complications. However, due to selection bias in this patient sample, this question cannot be definitively answered. Early fracture stabilization did not increase the prevalence of CNS complications.
- Published
- 1998
37. Toxic Epidermal Necrolysis
- Author
-
John L. Hunt, Joseph T. Murphy, and Gary F. Purdue
- Subjects
Pediatrics ,medicine.medical_specialty ,education.field_of_study ,Burn therapy ,Referral ,business.industry ,Mortality rate ,Rehabilitation ,Population ,Burn center ,medicine.disease ,Toxic epidermal necrolysis ,General Health Professions ,Emergency Medicine ,medicine ,Surgery ,Risk factor ,education ,business ,Total body surface area ,General Nursing - Abstract
Toxic epidermal necrolysis (TEN) is a poorly understood and devastating condition. It is usually diagnosed in a primary care setting. Treatment of severe cases by burn care personnel is usually by referral. In this review, we report excessive mortality rates associated with prolonged use of systemic steroid therapy and delayed referral (more than 1 week from diagnosis). Forty-four consecutive patients admitted to a regional burn center with the diagnosis of TEN over a 14-year period, (0.7% of all admissions) were included. Precipitating factors were identified in 30 cases. Twenty-one patients had known prehospital allergy conditions directly related to the inciting agent. The mean age of this population was 44.9 years, and the mean total body surface area (TBSA) injury was 52.4%. Eighty-four and one-half percent of all patients with TEN were admitted to the ICU. Twenty-four patients required ventilator support. Overall mortality rate was 36%. Nonsurviving patients had a mean age of 61.6 years, compared to 35.3 years for survivors. Nonsurvivors had a mean TBSA of 64.4%, survivors had a mean TBSA of 44%. TEN, although a nonthermal injury, is best managed by personnel experienced in the care of severe thermal injuries. Despite the availability of this expertise, delayed transfer of severe presentations continues to contribute to exceptionally high morbidity and mortality rates.
- Published
- 1997
38. Treatment of Femur Fracture with Associated Vascular Injury
- Author
-
Adam J. Starr, John L. Hunt, and Charles M. Reinert
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,medicine.medical_treatment ,education ,Femoral vein ,Amputation, Surgical ,Fracture Fixation, Internal ,Injury Severity Score ,Fracture fixation ,medicine ,Humans ,Internal fixation ,Popliteal Artery ,Child ,Retrospective Studies ,Gangrene ,Femur fracture ,Osteosynthesis ,business.industry ,Femoral Vein ,Middle Aged ,medicine.disease ,Surgery ,Femoral Artery ,Treatment Outcome ,Amputation ,Blood Vessels ,Female ,business ,Femoral Fractures - Abstract
Objective : The aim of this study was to determine (1) if internal fixation was associated with a high amputation rate in patients with femur fracture and vascular injury ; and (2) if patients who underwent internal fixation before vascular repair had a higher amputation rate. Design : This is a retrospective analysis. Materials and Methods : Twenty-six patients requiring femoral stabilization with injury to the superficial femoral artery, popliteal artery, or common femoral vein were studied. The Injury Severity Score and the Mangled Extremity Severity Score were calculated for each. Nineteen patients underwent internal fixation. Ten patients had internal fixation before vascular repair. Results : Sixteen of 19 patients treated with internal fixation had limb salvage. Nine of 10 patients who had internal fixation before vascular repair had limb salvage. Poor outcomes (gangrene, amputation, or death) were associated with a Mangled Extremity Severity Score ≥6 (p = 0.005). Conclusions : In these patients, poor outcome is associated with severe leg injury, (with a Mangled Extremity Severity Score of ≥6). Internal fixation can be safely used, and skeletal stabilization can be safely performed before vascular repair. If ischemic time is prolonged, vascular shunts should be used until skeletal stabilization is completed.
- Published
- 1996
39. Electrical injury
- Author
-
Brett D. Arnoldo, John L. Hunt, and Gary F. Purdue
- Published
- 2012
40. Prevention of burn injuries
- Author
-
Gary F. Purdue, Brett D. Arnoldo, and John L. Hunt
- Subjects
business.industry ,Medicine ,business - Published
- 2012
41. List of Contributors
- Author
-
Asle Aarsland, Naoki Aikawa, Ahmed M Al-Mousawi, Brett D Arnoldo, Juan P Barret, Robert E. Barrow, Debra A Benjamin, Patricia E Blakeney, Elisabet Børsheim, Ludwik K. Branski, Michael C Buffalo, Jiake Chai, Xin Chen, Dai H Chung, Kevin K Chung, Amalia Cochran, Nadja Colon, April Cowan, Robert H Demling, Alexis Desmoulière, Manuel Dibildox, Matthias B Donelan, Peter Dziewulski, Itoro E Elijah, Perenlei Enkhbaatar, E Burke Evans, Shawn P Fagan, James A Fauerbach, Michael J Feldman, Celeste C Finnerty, Christian Gabriel, James J Gallagher, Richard L Gamelli, Gerd G Gauglitz, Nicole S Gibran, Cleon W. Goodwin, Jeremy Goverman, Caran Graves, Herbert L Haller, Charles E Hartford, Hal K Hawkins, Sachin D Hegde, David M Heimbach, David N Herndon, Maureen Hollyoak, Ted Huang, John L Hunt, Mary Jaco, Marc Jeschke, Carlos J Jimenez, Andreas Jokuszies, Richard J Kagan, Lars-Peter Kamolz, Michael P Kinsky, Gordon L Klein, Eric Koch, George C Kramer, Peter Kwan, John Lawrence, Jong O Lee, Jorge Leon-Villapalos, Giavonni M Lewis, Eric C Liao, JF Aili Low, Arthur D Mason, Dirk M Maybauer, Marc O Maybauer, Robert L McCauley, Serina J McEntire, Walter John Meyer, Stephen M Milner, Ronald P Mlcak, Stephen E Morris, Elise M Morvant, David W Mozingo, Michael Muller, Erle D Murphey, Kuzhali Muthu, Andreas D Niederbichler, William B Norbury, Nora Nugent, Sheila Ott, Clifford Pereira, Rudolf C Peterlik, Laura J Porro, Joseph A Posluszny, Basil A Pruitt, Gary F. Purdue, Fengjun Qin, Edward C Robb, Noe A Rodriguez, Laura Rosenberg, Lior Rosenberg, Marta Rosenberg, Jeffrey R Saffle, Hiroyuki Sakurai, Arthur P Sanford, Syed M Sayeed, Cameron Schlegel, Michael A Serghiou, Ravi Shankar, Yuming Shen, Robert L Sheridan, Edward R Sherwood, Marcus Spies, Jose P Sterling, Oscar E Suman, Mark Talon, Christopher R Thomas, Tracy Toliver-Kinsky, Ronald G Tompkins, Daniel L Traber, Edward E Tredget, Lisa L Tropez-Arceneaux, Susanne Tropez-Sims, Cynthia G Villarreal, Peter M Vogt, Glenn D Warden, Petra M Warner, Christopher C Whitehead, Shelley A Wiechman, Mimmie Willebrand, Felicia N Williams, Natalie M Williams-Bouyer, Robert Winter, Steven E Wolf, Lee C Woodson, and Jui-Yung Yang
- Published
- 2012
42. Electrical injuries
- Author
-
Gary F. Purdue, Jose P. Sterling, John L. Hunt, and Brett D. Arnoldo
- Subjects
medicine.medical_specialty ,Physical medicine and rehabilitation ,business.industry ,medicine ,business ,Electrical Injuries - Published
- 2012
43. Eumops dabbenei
- Author
-
Lisa A. McWilliams, Troy L. Best, John L. Hunt, and Kevin G. Smith
- Subjects
Animal Science and Zoology ,Ecology, Evolution, Behavior and Systematics - Published
- 2002
44. Acute assessment and management of burn injuries
- Author
-
Gary F. Purdue, Brett D. Arnoldo, and John L. Hunt
- Subjects
Adult ,Patient Transfer ,Burn injury ,medicine.medical_specialty ,Body Surface Area ,Administration, Topical ,Burn Units ,Physical Therapy, Sports Therapy and Rehabilitation ,Compartment Syndromes ,Biological dressing ,Fluid therapy ,medicine ,Humans ,Medical nutrition therapy ,Intensive care medicine ,Child ,Trauma Severity Indices ,Biological Dressings ,business.industry ,Trauma Severity Indexes ,Rehabilitation ,Temperature ,Infant ,Skin Transplantation ,Burn units ,Middle Aged ,Skin transplantation ,Anti-Bacterial Agents ,Child, Preschool ,Fluid Therapy ,Nutrition Therapy ,Contracture ,medicine.symptom ,business ,Burns - Abstract
Burns are ubiquitous injuries in modern society, with virtually all adults having sustained a burn at some point in their lives. The skin is the largest organ of the body, basically functioning to protect self from non-self. Burn injury to the skin is painful, resource-intensive, and often associated with scarring, contracture formation, and long-term disability. Larger burns are associated with morbidity and mortality disproportionate to their initial appearance. Electrical and chemical burns are less common injuries but are often associated with significant morbidity.
- Published
- 2011
45. IL-10 polymorphism associated with decreased risk for mortality after burn injury
- Author
-
Robert Barber, Ryan M. Huebinger, John L. Hunt, Joseph P. Minei, Fernando A. Rivera-Chavez, Gary F. Purdue, Ling Yu Chang, Brett D. Arnoldo, and Ming Mei Liu
- Subjects
Adult ,Male ,medicine.medical_specialty ,Burn injury ,Genotype ,Single-nucleotide polymorphism ,Gastroenterology ,Polymorphism, Single Nucleotide ,Linkage Disequilibrium ,Article ,Cohort Studies ,Young Adult ,Risk Factors ,Internal medicine ,medicine ,Humans ,Hypoxia, Brain ,Promoter Regions, Genetic ,Spinal cord injury ,Spinal Cord Injuries ,Whole blood ,business.industry ,Odds ratio ,Middle Aged ,medicine.disease ,Surgery ,Interleukin-10 ,Cohort ,Female ,business ,Burns ,Total body surface area ,Cohort study - Abstract
Objective Evaluation of single nucleotide polymorphisms (SNPs) in the interleukin‑10 promoter (‑592 and ‑819) on risk for death after burn injury. Methods Association between the IL-10 SNPs and outcome after burn injury was evaluated in a cohort of 265 patients from Parkland Hospital, Dallas, TX with ≥15% TBSA burns without non-burn trauma (ISS ≤ 16), traumatic or anoxic brain injury or spinal cord injury, who survived >48 h under an IRB-approved protocol. Clinical data were collected prospectively and genotyping was conducted by TaqMan assay. Whole blood from 31 healthy volunteers was stimulated with LPS (100 ng/mL) to determine the level of IL-10 expression for each allele by enzyme-linked immunosorbent assay (ELISA). Results After adjustment for percent total body surface area (TBSA) burned, inhalation injury, age, gender, and race/ethnicity, carriage of ‑592A and/or ‑819T was significantly associated ( P = 0.014) with a decreased risk for death (adjusted odds ratio: 0.404; 95% CI: 0.197–0.829). As the candidate SNPs were in complete linkage disequilibrium, it was not possible to distinguish which allele was associated with decreased mortality risk. Age, inhalation injury, and full-thickness burn size were significantly associated with increased risk for death. In the LPS stimulated blood of healthy controls, carriage of the -592A and/or -819T allele demonstrated a trend for decreased levels of IL-10 ( P = 0.079). Conclusion Carriage of the ‑592A and/or ‑819T allele in the IL-10 promoter appears to reduce the risk for death after burn injury.
- Published
- 2010
46. The elderly burn patient
- Author
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John L. Hunt and Gary F. Purdue
- Subjects
Male ,medicine.medical_specialty ,Smoke Inhalation Injury ,Sepsis ,Postoperative Complications ,Tracheostomy ,Cause of Death ,Burns, Chemical ,Epidemiology ,medicine ,Humans ,In patient ,Intraoperative Complications ,Survival rate ,Aged ,Cause of death ,Aged, 80 and over ,business.industry ,Burns, Electric ,General Medicine ,Length of Stay ,medicine.disease ,Texas ,Surgery ,Survival Rate ,Etiology ,Female ,Burns ,business ,Total body surface area - Abstract
During a 16-year period, 547 patients who were older than 64 years of age with a mean total body surface area (TBSA) (third-degree burns) of 25% were treated. Etiologies were flame/flash in 81% of patients, scald in 11%, solids in 7%, and electrical/chemical in 1%. Seventeen percent of patients had significant causal factors. An inhalation injury was present in 13% of patients, and the mortality in these patients was 100%. Burn excision was performed 239 times in 165 patients. The majority of excisions were for full-thickness burns. Excision did not improve overall survival in patients with third-degree burns of 0% to 10%, but the length of stay (LOS) in excised and nonexcised survivors was improved (9 versus 21 days, respectively). The LOS and survival were not significantly different in patients with burns between 11% and 20%. Postburn complications occurred in 28% of patients. Overall mortality was 50% (mean age: 77 years; TBSA: 40%). There were no survivors with over 47% TBSA burns. The leading cause of death was pulmonary sepsis. Most surviving patients returned to a satisfactory lifestyle after discharge.
- Published
- 1992
47. A comparison of the geochemical features of some loess sections in New Zealand and China
- Author
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Wen Qizhong, Dennis N. Eden, and John L. Hunt
- Subjects
Paleontology ,Geochemistry and Petrology ,Clastic rock ,Loess ,Paleoclimatology ,Geochemistry ,Weathering ,Sedimentary rock ,Glacial period ,Paleosol ,Isotopes of oxygen ,Geology - Abstract
A comparison of the geochemical features of loesses of New Zealand and China indicates that the distributions of the elements and their variations reflect the fluctuations of climate which can be compared with the oxygen isotope stages and glacial periods.
- Published
- 1992
48. Acute Trauma of the Femoral Artery and Vein
- Author
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John L. Hunt, J S Cargile, and Gary F. Purdue
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Femoral vein ,Wounds, Penetrating ,Femoral artery ,Wounds, Nonpenetrating ,Critical Care and Intensive Care Medicine ,Fasciotomy ,medicine.artery ,medicine ,Humans ,Child ,Vein ,Aged ,Retrospective Studies ,Aged, 80 and over ,Femur fracture ,medicine.diagnostic_test ,Multiple Trauma ,business.industry ,Angiography ,Phlebography ,Femoral Vein ,Middle Aged ,medicine.disease ,Thrombosis ,Surgery ,Femoral Artery ,medicine.anatomical_structure ,Amputation ,Child, Preschool ,Radiology ,business ,Vascular Surgical Procedures - Abstract
Between 1974 and 1991, 233 patients were treated for 321 confirmed femoral vascular injuries. There were 112 patients (48%) with isolated arterial injuries, 36 (15%) with isolated venous injuries and 85 (36%) with combined arterial and venous injuries. Injury to the concomitant superficial or common vessels occurred in 27 (8.3%) and 9 (1.7%) patients, respectively. Associated extremity injuries included bone, 15%; soft tissue and muscle, 11%; and nerve, 7%. Sixty patients (26%) had fasciotomies. Arterial thrombosis occurred in five superficial repairs. Eighteen repaired veins thrombosed--eight of 61 simple (lateral venorrhaphy) and ten of 50 complex repairs. Thirty-four percent of patients with a repaired venous injury had clinical evidence of postoperative venous morbidity--deep vein thrombosis (DVT), edema, pulmonary embolus. Six patients (2.5%) had a documented pulmonary embolus--four in the 18 patients (22%) with clotted venous repairs. Eleven patients (4.7%) underwent an amputation. Five of the amputations were in patients with either inadequate or delayed fasciotomy. An inadequate fasciotomy was equally as deleterious as a delayed fasciotomy in terms of outcome. Six of 27 limbs (22%) with a femur fracture required an amputation. There were six deaths. Acute limb morbidity was related to the extent of associated limb trauma, i.e., soft-tissue, nerve, and bone damage. Chronic morbidity was related to neurologic deficits and venous sequelae. Vascular injury to the femoral vessels was associated with a high morbidity but low mortality.
- Published
- 1992
49. Inflammation and the host response to injury, a Large-Scale Collaborative Project: patient-oriented research core standard operating procedures for clinical care IX. Definitions for complications of clinical care of critically injured patients
- Author
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Ronald G. Tompkins, Henry V. Baker, Stephen F. Lowry, Carol L. Miller-Graziano, Robert L. Sheridan, Nicole S. Gibran, Avery B. Nathens, Robert J. Feezor, Mehmet Toner, John A. Mannick, Richard L. Gamelli, Heather L. Evans, Grant E. O'Keefe, Martin L. Yarmush, Ronald W. Davis, J. Perren Cobb, H. Shaw Warren, Ronald V. Maier, David A. Schoenfeld, Laurence G. Rahme, Bernard H. Brownstein, Joseph P. Minei, Michael West, Steven E. Wolf, Paul E. Bankey, Brian G. Harbrecht, Richard D. Smith, Steven E. Calvano, Vernon R. Young, David N. Herndon, Wenzhong Xiao, Joseph Cuschieri, Jeffrey L. Johnson, Daniel G. Remick, Michael N. Mindrinos, Chuck Cooper, John L. Hunt, Doug Hayden, Ernest E. Moore, Adrian Fay, Gregory Stephanopoulos, Timothy R. Billiar, Krzysztof Laudanski, Michael B. Shapiro, Geoffrey M. Silver, Lyle L. Moldawer, James A. Lederer, and Irshad H. Chaudry
- Subjects
Inflammation ,medicine.medical_specialty ,Research program ,business.industry ,Major trauma ,Best practice ,Medical record ,Host response ,MEDLINE ,Critical Care and Intensive Care Medicine ,medicine.disease ,Article ,Surgery ,Traumatic injury ,Scale (social sciences) ,Terminology as Topic ,Medicine ,Humans ,Surgical Wound Infection ,Wounds and Injuries ,Medical emergency ,business - Abstract
The Inflammation and Host Response to Injury Large-Scale Collaborative Research program, funded by the National Institute of General Medical Sciences of the National Institutes of Health, is the first large-scale interdisciplinary program to attempt to solve the life-threatening problem of inflammation after major trauma or burn injury. One of the main goals of the project was to develop a large clinical database with baseline patient characteristics and well-defined outcomes that pertain to the host inflammatory response after injury. To minimize the impact of practice variation between participating sites, clinical guidelines were developed at the outset of the project, based on the best available evidence in concert with expert consensus.1 The resultant standards of practice guidelines have been provided to the clinical community to ensure transparency of the research initiative, highlight the applicability of these best practices, and to promote the ongoing development of consistent, high-quality care. Recognizing the complexity and heterogeneity of the patient population, the investigators have additionally created a library of standardized diagnostic criteria for complications after traumatic injury. The method used to define these complications incorporated several key components. An expert panel of surgeons who were participating investigators in the Patient-Oriented Research Core was assembled to identify and enumerate the complications that arise after traumatic injury to be included in the study database. Definitions were based on the best available evidence and were clarified to attempt to unambiguously describe complications in such a manner that reliable data could be captured relative to that complication. Input into the consensus process was also obtained from trauma research nurses to modify the definitions to facilitate practical measurement of complications based on information available in the medical record. Although the primary intent was to maintain consistent reporting and quality assessment of treatment and outcomes among participating trauma centers, the compilation of these infectious and noninfectious complication definitions in a single source may serve as a useful reference for the clinician, as well as a framework for future research.
- Published
- 2009
50. Association of mitochondrial allele 4216C with increased risk for sepsis-related organ dysfunction and shock after burn injury
- Author
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Terence O'Keeffe, Agnes Burris, Brett D. Arnoldo, Daphne McGee, Ryan M. Huebinger, Ruben Gomez, Jureta W. Horton, Gary F. Purdue, Ling Yu Chang, Susan M. Friese, Robert Barber, John L. Hunt, and Jessica E. Bender
- Subjects
Adult ,Male ,medicine.medical_specialty ,Burn injury ,Genotype ,Multiple Organ Failure ,Critical Care and Intensive Care Medicine ,Gastroenterology ,DNA, Mitochondrial ,Polymerase Chain Reaction ,Polymorphism, Single Nucleotide ,Sepsis ,Young Adult ,Internal medicine ,Medicine ,Humans ,Genetic Predisposition to Disease ,Spinal cord injury ,Alleles ,business.industry ,Septic shock ,Organ dysfunction ,NADH Dehydrogenase ,Odds ratio ,Middle Aged ,medicine.disease ,Molecular biology ,Emergency Medicine ,Injury Severity Score ,Female ,medicine.symptom ,business ,Burns ,Total body surface area - Abstract
Impaired mitochondrial activity has been linked to increased risk for clinical complications after injury. Furthermore, variant mitochondrial alleles have been identified and are thought to result in decreased mitochondrial activity. These include a nonsynonymous mitochondrial polymorphism (T4216C) in the nicotinamide adenine dinucleotide dehydrogenase 1 gene (ND1), encoding a key member of complex I within the electron transport chain, which is found almost exclusively among Caucasians. We hypothesized that burn patients carrying ND1 4216C are less able to generate the cellular energy necessary for an effective immune response and are at increased risk for infectious complications. The association between 4216C and outcome after burn injury was evaluated in a cohort of 175 Caucasian patients admitted to the Parkland Hospital with burns covering greater than or equal to 15% of their total body surface area or greater than or equal to 5% full-thickness burns under an institutional review board-approved protocol. To remove confounding unrelated to burn injury, individuals were excluded if they presented with significant non-burn-related trauma (Injury Severity Score > or =16), traumatic or anoxic brain injury, spinal cord injury, were HIV/AIDS positive, had active malignancy, or survived less than 48 h postadmission. Within this cohort of patients, carriage of the 4216C allele was significantly associated by unadjusted analysis with increased risk for sepsis-related organ dysfunction or septic shock (P = 0.011). After adjustment for full-thickness burn size, inhalation injury, age, and sex, carriage of the 4216C allele was associated with complicated sepsis (adjusted odds ratio = 3.7; 95% confidence interval, 1.5-9.1; P = 0.005), relative to carriers of the T allele.
- Published
- 2009
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