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Article: Immunological Response to Subcutaneous and Intranasal Administration of SARS-CoV-2 Spike Protein in Mice.

Kinoshita, Mao / Muranishi, Kentaro / Kawaguchi, Ken / Sudo, Kazuki / Inoue, Keita / Ishikura, Hiroyasu / Sawa, Teiji

2024 Volume 12, Issue 4

Abstract: In novel coronavirus infection (COVID-19), the outbreak of acute lung injury due to trans-airway infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the starting point of severe disease. The COVID-19 pandemic highlights the ...

Abstract	In novel coronavirus infection (COVID-19), the outbreak of acute lung injury due to trans-airway infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the starting point of severe disease. The COVID-19 pandemic highlights the need for a vaccine that prevents not only the disease but also its infection. Currently, the SARS-CoV-2 vaccine is administered via intramuscular injection and is generally not immunogenic to the mucosa. As a result, current vaccinations fail to reduce viral shedding and transmission and ultimately do not prevent infection. We established a mouse vaccine model in which a single dose of S1 protein and aluminum oxide gel (alum) subcutaneous vaccine was followed by a booster dose of S1 protein and CpG oligodeoxynucleotide intranasal vaccine. The group that received two doses of the intranasal vaccine booster showed a significant increase in IgG and IgA antibody titers against S1 and RBD in serum and BAL, and a significant difference in neutralizing antibody titers, particularly in BAL. One intranasal vaccine booster did not induce sufficient immunity, and the vaccine strategy with two booster intranasal doses produced systemic neutralizing antibodies and mucus-neutralizing antibodies against SARS-CoV-2. It will be an important tool against the emergence of new viruses and the next pandemic.
Language	English
Publishing date	2024-03-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2703319-3
ISSN	2076-393X
ISSN	2076-393X
DOI	10.3390/vaccines12040343
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Article ; Online: Clinical impact of physician staffing transition in intensive care units: a retrospective observational study.

Fujii, Yosuke / Hirota, Kiichi / Muranishi, Kentaro / Mori, Yumiko / Kambara, Kei / Nishikawa, Yoshitaka / Hashiguchi, Mitsuko

BMC anesthesiology

2022 Volume 22, Issue 1, Page(s) 362

Abstract: Background: Intensivists play an essential role in improving the outcomes of critically ill patients in intensive care units (ICUs). The transition of ICU physician staffing from low-intensity ICUs (elective intensivist or no intensivist consultation) ... ...

Abstract	Background: Intensivists play an essential role in improving the outcomes of critically ill patients in intensive care units (ICUs). The transition of ICU physician staffing from low-intensity ICUs (elective intensivist or no intensivist consultation) to high-intensity ICUs (mandatory intensivist consultation or a closed ICU) improves clinical outcomes. However, whether a transition from high-intensity to low-intensity ICU staffing affects ICU outcomes and quality of care remains unknown. Methods: A retrospective observational study was conducted to examine the impact of high- versus low-intensity staffing models on all-cause mortality in a suburban secondary community hospital with 400 general beds and 8 ICU beds. The ICU was switched from a high-intensity staffing model (high-former period) to low-intensity staffing in July 2019 (low-mid period) and then back to high-intensity staffing in March 2020 (high-latter period). Patients admitted from the emergency department, general ward, or operating room after emergency surgery were enrolled in these three periods and compared, balancing the predicted mortality and covariates of the patients. The primary outcome was all-cause mortality analyzed using hazard ratios (HRs) from Cox proportional hazards regression. An interrupted time-series analysis (ITSA) was also conducted to evaluate the effects of events (level change) and time. Results: There were 962 eligible admissions, of which 251, 213, and 498 occurred in the high-former, low-mid, and high-latter periods, respectively. In the matched group (n = 600), the all-cause mortality rate comparing the high-former period with the low-mid period showed an HR of 0.88 [95% confidence interval (CI), 0.56, 1.39; p = 0.58] and that comparing the high-latter period with the low-mid period showed an HR of 0.84 [95% CI, 0.54, 1.30; p = 0.43]. The result for comparison between the three periods was p = 0.80. ITSA showed level changes of 4.05% [95% CI, -13.1, 21.2; p = 0.63] when ICU staffing changed from the high-former to the low-mid period and 1.35% [95% CI, -13.8, 16.5; p = 0.86] when ICU staffing changed from the low-mid to the high-latter period. Conclusion: There was no statistically significant difference in all-cause mortality among the three ICU staffing periods. This study suggests that low-intensity ICU staffing might not worsen clinical outcomes in the ICU in a medium-sized community hospital. Multiple factors, including the presence of an intensivist, other medical staff, and practical guidelines, influence the prognosis of critically ill patients.
MeSH term(s)	Humans ; Critical Illness/therapy ; Hospital Mortality ; Personnel Staffing and Scheduling ; Intensive Care Units ; Workforce ; Physicians
Language	English
Publishing date	2022-11-26
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2091252-3
ISSN	1471-2253 ; 1471-2253
ISSN (online)	1471-2253
ISSN	1471-2253
DOI	10.1186/s12871-022-01905-0
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Article: Antibody Response Following the Intranasal Administration of SARS-CoV-2 Spike Protein-CpG Oligonucleotide Vaccine.

Muranishi, Kentaro / Kinoshita, Mao / Inoue, Keita / Ohara, Junya / Mihara, Toshihito / Sudo, Kazuki / Ishii, Ken J / Sawa, Teiji / Ishikura, Hiroyasu

Vaccines

2023 Volume 12, Issue 1

Abstract: The new coronavirus infection causes severe respiratory failure following respiratory tract infection with severe acute respiratory syndrome-related coronavirus (SARS-CoV-2). All currently approved vaccines are administered intramuscularly; however, ... ...

Abstract	The new coronavirus infection causes severe respiratory failure following respiratory tract infection with severe acute respiratory syndrome-related coronavirus (SARS-CoV-2). All currently approved vaccines are administered intramuscularly; however, intranasal administration enhances mucosal immunity, facilitating the production of a less invasive vaccine with fewer adverse events. Herein, a recombinant vaccine combining the SARS-CoV-2 spike protein receptor-binding domain (RBD), or S1 protein, with CpG-deoxyoligonucleotide (ODN) or aluminum hydroxide (alum) adjuvants was administered intranasally or subcutaneously to mice. Serum-specific IgG titers, IgA titers in the alveolar lavage fluid, and neutralizing antibody titers were analyzed. The nasal administration of RBD protein did not increase serum IgG or IgA titers in the alveolar lavage fluid. However, a significant increase in serum IgG was observed in the intranasal group administered with S1 protein with CpG-ODN and the subcutaneous group administered with S1 protein with alum. The IgA and IgG levels increased significantly in the alveolar lavage fluid only after the intranasal administration of the S1 protein with CpG-ODN. The neutralizing antibody titers in serum and bronchoalveolar lavage were significantly higher in the intranasal S1-CpG group than in every other group. Hence, the nasal administration of the S1 protein vaccine with CpG adjuvant might represent an effective vaccine candidate.
Language	English
Publishing date	2023-12-20
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2703319-3
ISSN	2076-393X
ISSN	2076-393X
DOI	10.3390/vaccines12010005
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Article: Effect of a Novel Trivalent Vaccine Formulation against Acute Lung Injury Caused by

Inoue, Keita / Kinoshita, Mao / Muranishi, Kentaro / Ohara, Junya / Sudo, Kazuki / Kawaguchi, Ken / Shimizu, Masaru / Naito, Yoshifumi / Moriyama, Kiyoshi / Sawa, Teiji

Vaccines

2023 Volume 11, Issue 6

Abstract: An effective vaccine ... ...

Abstract	An effective vaccine against
Language	English
Publishing date	2023-06-11
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2703319-3
ISSN	2076-393X
ISSN	2076-393X
DOI	10.3390/vaccines11061088
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Article ; Online: Assessment of the prognosis, frequency, and isolated bacteria in ventilator-associated pneumonia among patients with severe coronavirus disease 2019 pneumonia: A single-center retrospective observational study.

Morimoto, Shinichi / Muranishi, Kentaro / Izutani, Yoshito / Maruyama, Junichi / Kato, Reijiro / Ninomiya, Shun / Nakamura, Yoshihiko / Kitamura, Taisuke / Takata, Tohru / Ishikura, Hiroyasu

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy

2023 Volume 30, Issue 6, Page(s) 499–503

Abstract: Introduction: Acute respiratory distress syndrome (ARDS) due to severe coronavirus disease 2019 (COVID-19) pneumonia is associated with a high incidence of ventilator-associated pneumonia (VAP). We aimed to evaluate the epidemiology of VAP associated ... ...

Abstract	Introduction: Acute respiratory distress syndrome (ARDS) due to severe coronavirus disease 2019 (COVID-19) pneumonia is associated with a high incidence of ventilator-associated pneumonia (VAP). We aimed to evaluate the epidemiology of VAP associated with severe COVID-19 pneumonia. Methods: This retrospective observational study recruited patients with COVID-19-associated ARDS admitted to our center from April 1, 2020, to September 30, 2021. The primary outcome was the survival-to-discharge rate. The secondary outcomes were the VAP rate, time to VAP, length of ICU stay, length of ventilator support, and isolated bacteria. Results: Sixty-eight patients were included in this study; 23 developed VAP. The survival-to-discharge rate was 60.9 % in the VAP group and 84.4 % in the non-VAP group. The median time to VAP onset was 16 days. The median duration of ventilator support and of ICU stay were higher in the VAP group than in the non-VAP group. The VAP rate was 33.8 %. The most common isolated species was Stenotrophomonas maltophilia. On admission, carbapenems were used in a maximum number of cases (75 %). Furthermore, the median body mass index (BMI) was lower and the median sequential organ failure assessment (SOFA) score on admission was higher in the VAP group than in the non-VAP group. Conclusions: The survival-to-discharge rate in VAP patients was low. Moreover, VAP patients tended to have long ICU stays, low BMI, and high SOFA scores on admission. Unusually, S. maltophilia was the most common isolated bacteria, which may be related to the frequent use of carbapenems.
MeSH term(s)	Humans ; Pneumonia, Ventilator-Associated/epidemiology ; Pneumonia, Ventilator-Associated/microbiology ; COVID-19/epidemiology ; COVID-19/complications ; Bacteria ; Prognosis ; Carbapenems/therapeutic use ; Respiratory Distress Syndrome ; Intensive Care Units ; Respiration, Artificial/adverse effects
Chemical Substances	Carbapenems
Language	English
Publishing date	2023-12-12
Publishing country	Netherlands
Document type	Observational Study ; Journal Article
ZDB-ID	1355399-9
ISSN	1437-7780 ; 1341-321X
ISSN (online)	1437-7780
ISSN	1341-321X
DOI	10.1016/j.jiac.2023.12.003
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Article ; Online: Glial fibrillary acidic protein level on admission can predict severe traumatic brain injury in patients with severe multiple trauma: A single-center retrospective observational study.

Nakamura, Yoshihiko / Kitamura, Taisuke / Kawano, Yasumasa / Hoshino, Kota / Irie, Yuhei / Muranishi, Kentaro / Iwaasa, Mitsutoshi / Ishikura, Hiroyasu

Current research in neurobiology

2022 Volume 3, Page(s) 100047

Abstract: Objective: This study aimed to clarify whether the glial fibrillary acidic protein (GFAP) and soluble protein-100β (S100β) can predict severe traumatic brain injury (TBI) in patients with severe multiple trauma.: Methods: This is a single-center ... ...

Abstract	Objective: This study aimed to clarify whether the glial fibrillary acidic protein (GFAP) and soluble protein-100β (S100β) can predict severe traumatic brain injury (TBI) in patients with severe multiple trauma. Methods: This is a single-center retrospective observational study of 179 patients with severe multiple trauma. The GFAP and S100β were measured upon patient arrival at the hospital. We divided the patients into the severe TBI group (with a Traumatic Coma Data Bank classification of ≥III), the non-severe TBI group (non-TBI group [absence of abnormality on the computed tomography scan and extracranial injury], and the mild to moderate TBI group [TCDB classification I and II]). We compared biomarker levels between the two groups and then evaluated the accuracy of predicting severe TBI using a receiver operating characteristic curve. Results: A total of 41 patients had severe TBI, and 138 had non-severe TBI. Mean GFAP levels were significantly higher in the severe TBI group (median, 6000 pg/mL; interquartile range [IQR], 651-15,548 pg/mL) than in the non-severe TBI group (median, 149 pg/mL; IQR, 0-695 pg/mL) (p < 0.0001). In contrast, there was no significant difference in S100β levels between the severe TBI group (median, 64 pg/mL; IQR, 0-536 pg/mL) and non-severe TBI group (median, 117 pg/mL; IQR, 0-403 pg/mL) (p = 0.637). The area under the receiver operating characteristic curve was 0.810 (p < 0.0001) for GFAP and 0.476 (p = 0.908) for S100β. For the GFAP, the optimal cutoff value for detecting severe TBI was 947 pg/mL (sensitivity, 75.6%; specificity, 78.3%). Conclusions: In patients with severe multiple trauma, the GFAP level at hospital arrival could predict severe TBI, whereas the S100β level was not a useful predictor.
Language	English
Publishing date	2022-08-13
Publishing country	Netherlands
Document type	Journal Article
ISSN	2665-945X
ISSN (online)	2665-945X
DOI	10.1016/j.crneur.2022.100047
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Article ; Online: Soluble fibrin is a useful marker for predicting extracorporeal membrane oxygenation circuit exchange because of circuit clots.

Hoshino, Kota / Muranishi, Kentaro / Kawano, Yasumasa / Hatomoto, Hiroki / Yamasaki, Shintaro / Nakamura, Yoshihiko / Ishikura, Hiroyasu

Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs

2018 Volume 21, Issue 2, Page(s) 196–200

Abstract: A circuit clot is one of the most frequent complications during extracorporeal membrane oxygenation (ECMO) support. We identify coagulation/fibrinolysis markers for predicting ECMO circuit exchange because of circuit clots during ECMO support. Ten ... ...

Abstract	A circuit clot is one of the most frequent complications during extracorporeal membrane oxygenation (ECMO) support. We identify coagulation/fibrinolysis markers for predicting ECMO circuit exchange because of circuit clots during ECMO support. Ten patients with acute pulmonary failure who underwent veno-venous ECMO were enrolled between January 2014 and December 2016. ECMO support lasted 106 days. The 6 days on which the ECMO circuits were exchanged were considered as circuit clot (+) group, while the remaining 100 days were considered as circuit clot (-) group. The predictors of ECMO circuit exchange because of circuit clots were identified. The mean duration of ECMO support was 10 ± 13 days, and the mean number of ECMO circuit exchange was 0.6 ± 1.1 times per patient. Thrombin-antithrombin complex (TAT) and soluble fibrin (SF) were higher in the circuit clot (+) group than in the circuit clot (-) group (both P < 0.01). According to a multivariate analysis, SF was the only independent predictor of ECMO circuit exchange (P < 0.01). The odds ratio (confidence intervals) for SF (10 µg/ml) was 1.20 (1.06-1.36). The area under the curve and optimal cut-off value were 0.95 and 101 ng/ml for SF (sensitivity, 100%; specificity, 89%). SF may be useful in predicting ECMO circuit exchange because of circuit clots.
MeSH term(s)	Aged ; Antithrombin III ; Biomarkers/blood ; Blood Coagulation ; Extracorporeal Membrane Oxygenation/adverse effects ; Female ; Fibrin/metabolism ; Humans ; Lung ; Male ; Middle Aged ; Peptide Hydrolases/blood ; Respiratory Insufficiency/therapy ; Retrospective Studies ; Thrombosis/blood ; Thrombosis/etiology
Chemical Substances	Biomarkers ; antithrombin III-protease complex ; Antithrombin III (9000-94-6) ; Fibrin (9001-31-4) ; Peptide Hydrolases (EC 3.4.-)
Language	English
Publishing date	2018-01-30
Publishing country	Japan
Document type	Journal Article
ZDB-ID	1463555-0
ISSN	1619-0904 ; 1434-7229
ISSN (online)	1619-0904
ISSN	1434-7229
DOI	10.1007/s10047-018-1021-x
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Zs.A 5024: Show issues

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Article ; Online: Outcomes in patients with infections and augmented renal clearance: A multicenter retrospective study.

Kawano, Yasumasa / Maruyama, Junichi / Hokama, Ryo / Koie, Megumi / Nagashima, Ryotaro / Hoshino, Kota / Muranishi, Kentaro / Nakashio, Maiko / Nishida, Takeshi / Ishikura, Hiroyasu

PloS one

2018 Volume 13, Issue 12, Page(s) e0208742

Abstract: Recently, augmented renal clearance (ARC), which accelerates glomerular filtration of renally eliminated drugs thereby reducing the systemic exposure to these drugs, has started to receive attention. However, the clinical features associated with ARC are ...

Abstract	Recently, augmented renal clearance (ARC), which accelerates glomerular filtration of renally eliminated drugs thereby reducing the systemic exposure to these drugs, has started to receive attention. However, the clinical features associated with ARC are still not well understood, especially in the Japanese population. This study aimed to evaluate the clinical characteristics and outcomes of ARC patients with infections in Japanese intensive care unit (ICU) settings. We conducted a retrospective observational study from April 2013 to May 2017 at two tertiary level ICUs in Japan, which included 280 patients with infections (median age 74 years; interquartile range, 64-83 years). We evaluated the estimated glomerular filtration rate (eGFR) at ICU admission using the Japanese equation, and ARC was defined as eGFR >130 mL/min/1.73 m2. Multivariable logistic regression analysis was performed to identify the independent risk factors for ARC and to determine if it was a predictor of ICU mortality. In addition, a receiver operating curve (ROC) analysis was performed, and the area under the ROC (AUROC) was determined to examine the significant variables that predict ARC. In total, 19 patients (6.8%) manifested ARC. Multivariable logistic regression analysis identified younger age as an independent risk factor for ARC (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.91-0.96). However, ARC was not found to be a predictor of ICU mortality (OR, 0.57; 95% CI, 0.11-2.92). In addition, the AUROC of age was 0.79 (95% CI, 0.68-0.91), and the optimal cut off age for ARC was ≤63 years (sensitivity, 68.4%; specificity, 78.9%). The incidence of ARC was, therefore, low among patients with infections in the Japanese ICUs. Although younger age was associated with the incidence of ARC, it was not an independent predictor of ICU mortality.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Critical Care ; Glomerular Filtration Rate ; Humans ; Incidence ; Infections/diagnosis ; Infections/metabolism ; Infections/mortality ; Infections/therapy ; Intensive Care Units ; Kidney/metabolism ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity
Language	English
Publishing date	2018-12-10
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Observational Study
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0208742
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Article: Augmented renal clearance in Japanese intensive care unit patients: a prospective study.

Kawano, Yasumasa / Morimoto, Shinichi / Izutani, Yoshito / Muranishi, Kentaro / Kaneyama, Hironari / Hoshino, Kota / Nishida, Takeshi / Ishikura, Hiroyasu

Journal of intensive care

2016 Volume 4, Page(s) 62

Abstract: Background: Augmented renal clearance (ARC) of circulating solutes and drugs has been recently often reported in intensive care unit (ICU) patients. However, only few studies on ARC have been reported in Japan. The aims of this pilot study were to ... ...

Abstract	Background: Augmented renal clearance (ARC) of circulating solutes and drugs has been recently often reported in intensive care unit (ICU) patients. However, only few studies on ARC have been reported in Japan. The aims of this pilot study were to determine the prevalence and risk factors for ARC in Japanese ICU patients with normal serum creatinine levels and to evaluate the association between ARC and estimated glomerular filtration rate (eGFR) calculated using the Japanese equation. Methods: We conducted a prospective observational study from May 2015 to April 2016 at the emergency ICU of a tertiary university hospital; 111 patients were enrolled (mean age, 67 years; interquartile range, 53-77 years). We measured 8-h creatinine clearance (CL Results: In total, 43 patients (38.7 %) manifested ARC. Multiple logistic regression analysis was performed for age, body weight, body height, history of diabetes mellitus, Acute Physiology and Chronic Health Evaluation II scores, admission categories of post-operative patients without sepsis and trauma, and serum albumin, and only age was identified as an independent risk factor for ARC (odds ratio, 0.95; 95 % confidence interval [CI], 0.91-0.98). Moreover, the AUROC of ARC for age and eGFR was 0.81 (95 % CI, 0.72-0.89) and 0.81 (95 % CI, 0.73-0.89), respectively. The optimal cutoff values for detecting ARC were age and eGFR of ≤63 years (sensitivity, 72.1 %; specificity, 82.4 %) and ≥76 mL/min/1.73 m Conclusions: ARC is common in Japanese ICU patients, and age was an independent risk factor for ARC. In addition, age and eGFR calculated using the Japanese equation were suggested to be useful screening tools for identifying Japanese patients with ARC.
Language	English
Publishing date	2016-10-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2739853-5
ISSN	2052-0492
ISSN	2052-0492
DOI	10.1186/s40560-016-0187-7
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Article ; Online: Early predictors for massive transfusion in older adult severe trauma patients.

Ohmori, Takao / Kitamura, Taisuke / Ishihara, Junko / Onishi, Hirokazu / Nojima, Tsuyoshi / Yamamoto, Kotaro / Tamura, Ryu / Muranishi, Kentaro / Matsumoto, Toshiyuki / Tokioka, Takamitsu

Injury

2016 Volume 48, Issue 5, Page(s) 1006–1012

Abstract: Background: Many scoring systems for the early prediction of the need for massive transfusion (MT) have been reported; in most of these, vital signs are regarded as important. However, the validity of these scoring systems in older patients remains ... ...

Abstract	Background: Many scoring systems for the early prediction of the need for massive transfusion (MT) have been reported; in most of these, vital signs are regarded as important. However, the validity of these scoring systems in older patients remains unclear because older trauma patients often present with normal vital signs. In this study, we investigated the effectiveness of previously described scoring systems, as well as risk factors that can provide early prediction of the need for MT in older severe trauma patients. Methods: We prospectively collected data from a cohort of severe trauma patients (ISS ≥16 and age ≥16years) admitted from January 2007 to March 2015. Trauma Associated Severe Hemorrhage (TASH), Assessment of Blood Consumption (ABC), and Prince of Wales Hospital (PWH) scores were compared between a younger and an older group. Furthermore, the predictors associated with MT in older severe trauma patients were assessed using multivariable logistic regression analyses. Results: The area under the curve (AUC) was significantly smaller for older group than for younger group for all three scoring systems (p<0.05). The most important risk factors to predict the need for MT were related to anatomical factors including FAST results (odds ratio (OR): 5.58, 95% confidence interval (CI): 2.10-14.99), unstable pelvic fracture (OR: 21.56, 95% CI: 6.05-90.78), and long bone open fracture of the lower limbs (OR: 12.21, 95% CI: 4.04-39.09), along with pre-injury anticoagulant agent use (OR: 5.22, 95% CI: 1.30-19.61), antiplatelet agent use (OR: 3.81, 95% CI: 1.57-9.04), lactate levels (OR: 1.20, 95% CI: 1.04-1.39) and shock index (OR: 2.67, 95% CI: 1.05-6.84). Traditional vital signs were not early risk factors. Conclusion: We suggest that MT in older trauma patients should be considered on the basis of anatomical factors, pre-injury anticoagulant or antiplatelet agent use, lactate level and SI even if traditional vital signs are normal.
MeSH term(s)	Adolescent ; Adult ; Age Factors ; Aged ; Area Under Curve ; Blood Transfusion/utilization ; Comorbidity ; Female ; Hemorrhage/mortality ; Hemorrhage/physiopathology ; Hemorrhage/therapy ; Humans ; Japan/epidemiology ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; ROC Curve ; Risk Factors ; Trauma Severity Indices ; Wounds and Injuries/mortality ; Wounds and Injuries/physiopathology ; Wounds and Injuries/therapy ; Young Adult
Language	English
Publishing date	2016-12-29
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2016.12.028
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