title: Transient regional hypothermia applied to a traumatic limb attenuates distant lung injury following blast limb trauma.
abstract: OBJECTIVE
  Explosive traumatic injury to an extremity may lead to both local and distant organ injury. Regional traumatic tissue hypothermia has been reported to offer systemic protection; here we investigated the protective effects of regional limb hypothermia on local tissue trauma and the lungs. Furthermore, the optimal duration of regional traumatic limb hypothermic treatment was also evaluated.
  
  
  METHODS
  Prospective, controlled, animal study.
  
  
  METHODS
  University research laboratory.
  
  
  METHODS
  Adult male Sprague-Dawley rats.
  
  
  METHODS
  Anesthetized rats were randomized to sham, blast limb trauma, sham and regional hypothermia for 30 minutes, and blast limb trauma and regional hypothermia for 30 minutes, 60 minutes, and 6 hours. Blast limb trauma was created using chartaceous electricity detonators.
  
  
  RESULTS
  Distant lung and local tissue injury following blast limb trauma were attenuated by regional traumatic limb hypothermic treatment for 30 minutes, 60 minutes, and 6 hours reflected by reduced lung histopathological changes and water content. Regional traumatic limb hypothermic treatment for 60 minutes and 6 hours failed to further attenuate distant lung and local tissue injury compared with regional traumatic limb hypothermic treatment for 30 minutes. Inhibition of cystathionine gamma-lyase/hydrogen sulfide was reduced by regional traumatic limb hypothermic treatment for 30 minutes in blast limb trauma rats. A surrogate of neutrophil accumulation, myeloperoxidase activity, and release of tumor necrosis factor-α and interleukin-6 were also attenuated by regional traumatic limb hypothermic treatment for 30 minutes in blast limb trauma rats. Oxidative stress was alleviated by regional traumatic limb hypothermic treatment for 30 minutes evidenced by reduction of hydrogen peroxide and malondialdehyde and an increase of superoxide dismutase and glutathione in blast limb trauma rats.
  
  
  CONCLUSIONS
  Our data indicate that regional traumatic limb hypothermic treatment for 30 minutes offers both local protection for traumatic tissue and systemic protection for the lungs, which is likely associated with restoration of the cystathionine gamma-lyase/hydrogen sulfide pathway and inhibition of the inflammatory response and oxidative stress.
authors.affiliation: 1Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China. 2Department of Nephrology, People's Liberation Army Chengdu Military Area Command General Hospital, Chengdu, Sichuan, China. 3Department of Hepatology, Xinqiao Hospital, Third Military Medical University, Chongqing, China. 4State Key Laboratory of Trauma and Burns, Surgery Research Institute, Department of Traumatic Surgery, Daping Hospital, Third Military Medical University, Chongqing, China. 5Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom. 6Surgical Outcomes Research Centre, University College London Hospital & Wellcome Department of Imaging Neuroscience, University College London, London, United Kingdom.
authors.forename: Jiaolin
authors.initials: J
authors.lastname: Ning
authors.forename: Liwen
authors.initials: L
authors.lastname: Mo
authors.forename: Hongzhi
authors.initials: H
authors.lastname: Zhao
authors.forename: Kaizhi
authors.initials: K
authors.lastname: Lu
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Xinan
authors.initials: X
authors.lastname: Lai
authors.forename: Bob
authors.initials: B
authors.lastname: Yang
authors.forename: Hailin
authors.initials: H
authors.lastname: Zhao
authors.forename: Robert D
authors.initials: RD
authors.lastname: Sanders
authors.forename: Daqing
authors.initials: D
authors.lastname: Ma
mesh_terms: D000818:Animals; D001753:Blast Injuries / Q000150:complications* / Q000628:therapy; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000502:physiology; D004195:Disease Models, Animal; D005978:Glutathione / Q000097:blood; D006861:Hydrogen Peroxide / Q000097:blood; D007036:Hypothermia, Induced / Q000379:methods*; D015850:Interleukin-6 / Q000097:blood; D007869:Leg Injuries / Q000150:complications* / Q000628:therapy; D008168:Lung / Q000473:pathology; D055370:Lung Injury / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D009195:Peroxidase / Q000097:blood; D051381:Rats; D017207:Rats, Sprague-Dawley; D013482:Superoxide Dismutase / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D008315:Malondialdehyde; D006861:Hydrogen Peroxide; D009195:Peroxidase; D013482:Superoxide Dismutase; D005978:Glutathione