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© 2015 Moore et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Im

Background: Respiratory failure is a serious complication that can adversely affect the hospital course and survival of multiply injured patients. Some studies have suggested that delayed surgical stabilization of spine fractures may increase the incidence of respiratory complications. However, the authors of these studies analyzed small sets of patients and did not assess the independent effects of multiple risk factors.Methods: A retrospective cohort study was conducted at a regional level-I trauma center to identify risk factors for respiratory failure in patients with surgically treated thoracic and lumbar spine fractures. Demographic, diagnostic, and procedural variables were identified. The incidence of respiratory failure was determined in an adult respiratory distress syndrome registry maintained concurrently at the same institution. Univariate and multivariate analyses were used to determine independent risk factors for respiratory failure. An algorithm was formulated to predict respiratory failure.Results: Respiratory failure developed in 140 of the 1032 patients in the study cohort. Patients with respiratory failure were older; had a higher mean Injury Severity Score (ISS) and Charlson Comorbidity Index Score; had greater incidences of pneumothorax, pulmonary contusion, and thoracic level injury; had a lower mean Glasgow Coma Score (GCS); were more likely to have had a posterior surgical approach; and had a longer mean time from admission to surgical stabilization than the patients without respiratory failure (p < 0.05). Multivariate analysis identified five independent risk factors for respiratory failure: an age of more than thirty-five years, an ISS of > 25 points, a GCS of < or = 12 points, blunt chest injury, and surgical stabilization performed more than two days after admission. An algorithm was created to determine, on the basis of the number of preoperative predictors present, the relative risk of respiratory failure when surgery was delayed for more than two days.Conclusions: Independent risk factors for respiratory failure were identified in an analysis of a large cohort of patients who had undergone operative stabilization of thoracic and lumbar spine fractures. Early operative stabilization of these fractures, the only risk factor that can be controlled by the physician, may decrease the risk of respiratory failure in multiply injured patients. [ABSTRACT FROM AUTHOR]

We studied erythropoietic activity in relation to the rearfoot cushioning of shoes worn by 14 male runners before, during, and the morning after a 17-day period of increased training mileage. The percentage of reticulocytes in the red blood cell count (normal, < 0.8%) served as the marker for erythropoietic activity. Each runner was assigned to either a firm-sole group (7) or a soft-sole group (7) according to the heel impact attenuation character (Peak g) of his shoes. Peak g was 18% greater in the firm-sole group (P < 0.001). Otherwise, the groups were similar in physical characteristics, training mileage, and running ability. All subjects ran a total of 430 km, a distance that averaged 79% higher than their regular training distance for a 17-day period. Resting blood samples were obtained at baseline and on three mornings (Days 11, 13, and Day 18, which followed the completion of the increased training period). No significant differences were found between the groups in red blood cell count, hematocrit, or total hemoglobin, haptoglobin, plasma-free hemoglobin, and serum ferritin levels. The groups did not differ in percent reticulocytes at baseline (0.2% firm-sole versus 0.2% soft-sole), on Day 11 after running 280 km (0.8% firm-sole versus 0.8% soft-sole), or on Day 13 after 48 hours of rest (1.3% firm-sole versus 1.0% soft-sole). However, in Day 18 after running 430 km, reticulocyte counts were 29% higher (P < 0.05) in firm-sole than soft-sole (2.2% versus 1.7%, respectively). The overall change in percent reticulocytes was linearly correlated with Peak g (r = 0.57, P < 0.05). Although marked reticulocytosis occurred in both groups, it was significantly more pronounced in the firm-sole group. The positive correlation between percent reticulocytes and Peak g suggests that shoe rear-foot cushioning is one determinant of the erythropoietic response to increased training mileage in distance runners. [ABSTRACT FROM AUTHOR]

Severe burns lead to insulin resistance, which is associated with hyperglycemia and muscle wasting. Investigators showed relatively recently that control of hyperglycemia with intensive insulin treatment is associated with improved outcomes for those in the intensive care unit, including patients with severe burns. In this article, we review the actions of insulin in terms of glycemic control and muscle metabolism, biochemical and clinical effects of insulin treatment in the severely burned, and the vagaries of glucose control. [ABSTRACT FROM AUTHOR]