Temperature and Humidity Stability of Fibre Optic Sensor Cables for High Resolution Measurements.

Fibre optic sensors offer a means for the real-time continuous measurement of temperature or strain in concrete structures. Backscattered light along a fibre optic sensing (FOS) cable is interrogated to record a frequency shift and this shift is typically translated into a physical parameter such as strain or temperature using a calibration factor. However, when the measured frequency shift is a response to a combination of mechanical, thermal or hygral (humidity) loadings it is difficult to decouple individual influences. This presents a challenge in complex materials such as concrete where the strain, temperature and moisture levels change concurrently during the fresh and hardened states. Furthermore, depending on the application, both short- and longer-term measurements are required. As such, not only is the influence of these physical factors of interest but also the time and spatial stability of the measured frequency, which is highly dependent on the FOS cable composition. To investigate this aspect, fibre optic cables commonly used for strain (three tight-buffered cables) or temperature (two loose-buffered cables) measurement were considered. The cables were subjected to mechanical or environmental exposure and interrogated using a high-resolution optical backscatter reflectometer. The exposure regimes included three temperature cycles with sustained steps from 10 °C to 60 °C and back to 10 °C and an increasing and decreasing humidity cycle with steps between 30 to 90% relH. These ranges were selected to be indicative of typical environments for concrete. The results showed that the calibration factors back-calculated from increasing and decreasing temperature or humidity cycles differed. The third temperature cycle results were found to exhibit the smallest differences between heating and cooling suggesting that temperature pre-conditioning prior to installation could be advantageous. For all the cables, a drift in the readings was observed over the duration (2.5 h for temperature and 30 h for moisture) of the sustained steps. The magnitude of the drift depended on the cable type and exposure condition. In addition, local frequency fluctuations along the cable were observed which would need to be taken into account if only a single point along the cable length was used for analysis. The obtained results highlight the importance of the cable selection to maximise the FOS measurement fidelity for a given parameter of interest.

Subsequent gene expression pattern in dendritic cells following multiple trauma.

PURPOSE: Major trauma initiates a systemic inflammatory response, which is characterized by systemic release of various chemokines. There is growing evidence for the extraordinary role of dendritic cells (DC) as professional antigen-presenting cells and activators of the immune response. Recently, the impact of severe trauma on DC transcriptomic activation was demonstrated. The purpose of the present study was to evaluate gene expression pattern in DC following multiple trauma to gain further understanding of the mechanisms of posttraumatic immune response. METHODS: Ten patients with multiple injuries aged 20 to 46 years (mean 30 ± 9.2 years) were included in this study. The mean injury severity score (ISS) was 36 ± 10.4 points. Repeated blood samples were taken on the day of admission (day 0) and on five consecutive days (day 1 to day 5). Microarray analysis and RT-qPCR were performed in primary isolated DC. RESULTS: A mean of 116,000 ± 21,466 DC with a purity of 96 ± 0,8 % were harvested. Gene expression of CCL5 and CXCL5 as well as TIMP1 and GUCY1B3 showed a significant increase within the first 4 days after trauma. The time-dependent increase of these genes correlated significantly with serum CRP concentration and the total number of DC but neither with age nor with injury severity. CONCLUSIONS: Our study provides new data regarding temporal expression patterns of CCL5, CXCL5, TIMP1, and GUCY13B in multiple trauma. DC activation following trauma may follow a uniform pattern early after admission, eventually leading to cell recruitment.

Intestinal-FABP and liver-FABP: Novel markers for severe abdominal injury.

OBJECTIVES: Fatty acid-binding proteins (FABPs) have relatively high tissue concentrations and low plasma concentrations and are released into the circulation following organ injury. We explored the utility of intestinal-(I)-FABP and liver-(L)-FABP for the diagnosis of abdominal injury in patients with multiple trauma. METHODS: This prospective study included 102 trauma patients and 30 healthy volunteers. Plasma I-FABP and L-FABP levels were measured in the emergency department (ED) by enzyme-linked immunosorbent assay (ELISA). Forty-one patients suffered from serious or severe abdominal trauma (Abbreviated Injury Score [AIS] code "ai" for abdominal injury, AISai > or = 3) and nine were moderately abdominally injured (AISai < 3). Fifty-two had no abdominal injury. RESULTS: Median I-FABP and L-FABP levels in the AISai > or = 3 group (516 pg/mL and 135 ng/mL, respectively) were significantly higher compared to the AISai < 3 group (154 pg/mL and 13 ng/mL, respectively) or those without abdominal injury (207 pg/mL and 21 ng/mL, respectively) or normal controls (108 pg/mL and 13 ng/mL, respectively). The cutoff to distinguish the ai > or = 3 is 359 pg/mL for I-FABP and 54 ng/mL for L-FABP, with 93% specificity and 75% sensitivity for I-FABP and 93% and 82% for L-FABP, respectively. CONCLUSIONS: High I-FABP and L-FABP levels correlate with relevant severity of abdominal tissue damage in patients with multiple trauma. I-FABP and L-FABP could be useful as markers for the early detection of significant abdominal injury in acute multiple trauma and identify patients who require rapid intervention.

Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures.

OBJECTIVES: Proximal humeral fractures account for approximately 5% of all fractures. New plating techniques have been developed to improve stability. The purpose of this study was to evaluate functional outcome following plate fixation with the Proximal Humeral Internal Locking System (PHILOS) and to analyze potential implant-related complications. METHODS: The PHILOS plate was used for internal fixation of displaced proximal humeral fractures in 28 patients (20 females, 8 males; mean age 60.7+/-12.9 years). Fractures were caused by low-energy trauma (fall from standing height) in 21 patients, and by an accident while skiing or cycling in seven patients. Involvement was on the right in 16 cases and on the left in 12 cases. According to the Neer classification, 8, 12, and 8 patients had displaced 2-, 3-, or 4-part fractures, respectively. All patients received a similar physical therapy program following internal fixation with the PHILOS plate. The patients were assessed clinically and radiographically after a mean follow-up of 25.2+/-11.8 months. Functional outcome was assessed using the Constant-Murley score adjusted for age and gender. Range of motion and shoulder abduction strength were measured. The patients were also evaluated with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and a visual analog scale (VAS). Complications during the follow-up period were recorded. RESULTS: Twenty fractures (71.4%) healed in good anatomical position. At the end of the follow-up period, the mean Constant-Murley score was 57.9+/-21.7, and the mean age- and gender-adjusted Constant-Murley score was 67.5+/-23.6. The results were excellent or good in 16 patients (57.1%), moderate in one patient (3.6%), and poor in 11 patients (39.3%). The mean DASH and VAS scores were 28.3+/-24.3 and 75.4+/-21.2, respectively. Eleven complications (39.3%) were seen during the follow-up period. Reoperation was required in eight patients (72.3%). Complications included avascular necrosis of the humeral head in two patients (7.2%), subacromial impingement in six patients (21.4%), loosening of a locking head screw in one patient (3.6%), and transiently decreased radial nerve sensation in two patients (7.2%). Subacromial impingement was mainly caused by the superior plate position. CONCLUSION: Our results demonstrate that the PHILOS plate provides sufficient fracture stabilization in the treatment of proximal humeral fractures of elderly patients.

Platelet factor 4 is highly upregulated in dendritic cells after severe trauma.

Dendritic cells (DCs) represent an important linkage between the innate and adaptive immune system and express proinflammatory transcriptomic products early after trauma. The use of a genomic approach recently revealed that platelet factor 4 (PF4) is significantly upregulated in DCs in patients after multiple trauma. However, knowledge about subsequent PF4 alteration and its potential clinical relevance in the context of multiple trauma is still limited. We used quantitative reverse transcription-polymerase chain reaction to analyze PF4 expression in both myeloid DCs (MDCs) and plasmocytoid DCs (PDCs) isolated from 10 patients after multiple trauma. Intracellular PF4 as well as HLA-DR expression were detected by flow cytometry. Furthermore, DCs and peripheral blood mononuclear cells were incubated on a monolayer of human umbilical endothelial cells and their adhesion properties were analyzed. The ratio of the DC subtypes (MDC and PDC) was assessed by flow cytometry. PF4 expression significantly increased on d 1 and d 2 as measured by reverse transcription-polymerase chain reaction. Intracellular PF4 content in MDCs and PDCs was significantly elevated in trauma patients compared with healthy controls. In addition, the surface antigen HLA-DR on MDCs was significantly elevated on d 1 and d 4 after trauma in patients compared with controls. However, cell adhesion of DCs did not show any significant differences between patients and controls. PF4 concentration in MDCs and PDCs significantly correlated with the injury severity score. These results confirm an early and subsequent posttraumatic activation of PF4 in DCs. PF4 also participates in the posttraumatic activation of DCs in relation to injury severity, a role that might be preferably based on the modification of receptor expression, whereas adhesion properties are largely unaffected.

Apoptosis differs in dendritic cell subsets early after severe trauma.

Dendritic cells (DC) represent an integral part of the immune system. However it is unclear how apoptosis in myeloid DC (MDC) and plasmacytoid DC (PDC) is affected and whether pro- or antiapoptotic properties dominate during the early post-traumatic phase. Blood samples were obtained on day 1 and day 4 after hospital admission from 10 severely traumatized patients and 10 healthy volunteers. Mononucleated cells were isolated and incubated with LPS. Apoptosis of MDC and PDC was assessed by annexin-V staining using flow cytometry. Expression of genes involved in apoptosis (Caspase-8, Flice inhibitory protein [FLIP], Bcl-2, Bax, Gadd45) in DC was measured by reverse transcriptase polymerase chain reaction. For statistical evaluation, the Kruskal-Wallis test was used (p < 0.05). Severe trauma increased apoptotic MDC compared with those in healthy controls (p < 0.05), whereas apoptosis of PDC was not influenced by the trauma impact. LPS stimulation decreased MDC apoptosis until day 4 after trauma; by contrast, for PDCs this effect was present only on day 1 after trauma. The Bcl-2/Bax ratio in DCs increased significantly. We conclude that peripheral MDCs are more susceptible to undergo apoptosis after trauma compared with PDCs. However, the overall response of DCs early after trauma is characterized by an increased activation of antiapoptotic mediators that might indicate a compensatory life-prolonging reaction.

Suppression and recovery of LPS-stimulated monocyte activity after trauma is correlated with increasing injury severity: a prospective clinical study.

BACKGROUND: Monocytes represent a key immunocompetent cell type, whose functional capacity is profoundly influenced by systemic trauma. Because data on monocyte function in a heterogeneous trauma population, including slightly injured patients, is limited, we evaluated whether the magnitude of monocyte dysfunction can be related with injury severity and is useful as a predictive biomarker for development of systemic inflammatory response syndrome (SIRS) and sepsis. METHODS: Blood samples were obtained from 58 patients at admission to a level 1 Trauma Unit (mean injury severity score [ISS] of 25.7; range 4-75), and daily for five successive days. Monocyte activity was assessed by measuring lipopolysaccharide (LPS)-stimulated interleukin (IL)-1-beta production. Levels of IL-6, IL-10, and procalcitonin were also determined and values were correlated to injury severity and occurrence of SIRS. RESULTS: Even mildly injured individuals (ISS 1-8) showed a significant suppression of the LPS-response directly upon admission (p < 0.05). Both LPS-response (p = 0.049) and IL-6 levels (p = 0.046) were found to be predictive for the presence/diagnosis of SIRS. After minor trauma (ISS 1-8), the LPS-response returned to normal levels by day 2, whereas in more severely injured patients (ISS > or = 25) the suppression of monocyte activity persisted for the duration of the study period. CONCLUSION: The extent of suppression of monocyte function is directly associated with the severity of trauma in both severely injured and patients with minor trauma. Acute posttraumatic changes in monocyte function and IL-6 concentrations were both predictive for the development of SIRS/sepsis. Although monocyte function in mildly injured patients is restored shortly after injury, the observed delay in recovery in severely traumatized patients may critically influence the clinical course.

Significant decline of peripheral myeloid dendritic cells following multiple trauma.

BACKGROUND: Dendritic cells (DC) represent an important and integral part of the immune system and are potent initiators of inflammation. Two distinct subsets of DC have been identified: myeloid DC (MDC) and plasmacytoid DC (PDC), which differ widely in many respects. Despite the importance of the DC in the inflammatory response that occurs after severe multiple injury, there is a profound lack of information regarding the distribution and regulation of DC subtypes following multiple trauma. The main goal of this study was to assess whether the normal distribution of circulating DC subpopulations is altered during the first 5 d after multiple trauma. PATIENTS AND METHODS: Sixty-three patients with multiple trauma (ISS 31 +/- 15 points) and 11 healthy volunteers (control group) were enrolled. Blood samples were taken on admission (D0) and daily for the following 5 d. The percentages of MDC and PDC were determined by flow cytometry. RESULTS: A significant decline of the MDC concentration was observable on days 3 to 5 after admission in comparison to the values obtained on the day of admission. The ratio of MDC to PDC decreased significantly (3-fold, P < 0.05). This reduction correlated significantly with changes observed in the plasma concentrations of IL-10 (r = 0.5; P < 0.05). DISCUSSION: Our data demonstrate that multiple trauma is followed by a marked change in the subpopulation composition of the DC compartment, and that these changes are inversely associated with enhanced IL-10 plasma concentrations. This imbalance in the DC compartment favoring PDC concentrations may contribute to the immunological alterations that are observed following multiple trauma.

Serum procalcitonin levels in patients with multiple injuries including visceral trauma.

Procalcitonin (PCT) is known to be a reliable biomarker of sepsis and infection. Elevation of serum or plasma PCT has also been observed after major surgery or trauma. The association of PCT with the severity or location of injury in multiple traumatized (polytrauma) patients has not been clearly established, to date. The aim of this study was therefore to evaluate the sensitivity of PCT as a biomarker for the diagnosis of abdominal trauma. In a prospective clinical study, PCT, interrleukin-6, and C-reactive protein were measured in blood (serum) samples obtained in the emergency room (D0) from 74 patients with multiple injuries and in serum samples obtained on the 2 days after trauma (D1, D2). PCT significantly increased during the first two posttraumatic days in patients with severe multiple injuries (n = 24, day 1: 3.37 ng/mL +/- 0.92 ng/mL; day 2: 3.27 ng/mL +/-0.97 ng/mL) as compared with patients with identical Injury Severity Score but without abdominal injury (day 1: 0.6 ng/mL +/- 0.18 ng/mL; 0.61 ng/mL +/- 0.21 ng/mL). Interrleukin-6 and C-reactive protein serum levels were not able to discriminate between patients with and without abdominal injury during the 2-day posttrauma observation period. In a specific evaluation of the abdominal injury pattern, a significant increase of serum PCT concentrations was observed on day 1 after trauma of the liver (4.04 ng/mL +/- 0.99 ng/mL) and the gut (4.63 ng/mL +/- 1.12 ng/mL) compared with other abdominal lesions (0.62 ng/mL +/- 0.2 ng/mL). Markedly elevated PCT concentrations were also evident after severe multiple injuries, including the liver/spleen in combination with thorax trauma (9.37 ng/mL +/- 2.71 ng/mL). Assessment of serum PCT seems to be significantly increased after abdominal trauma in severe multiple traumatized patients and may serve as a useful biomarker to support other diagnostic methods including ultrasound and CT scan. Although elevated levels of PCT during the first 2 days after trauma are more likely to be indicative of traumatic impact than of an ongoing status of sepsis, multiple events such as surgery, massive transfusion, and intensive care therapy might influence the PCT concentration.

Midterm results after operatively stabilised shoulder dislocations in elderly patients.

Anterior shoulder dislocation is frequently seen in young patients. The therapeutic regime in elderly patients after shoulder dislocation is less clearly defined. The aim of this study was to compare the clinical benefit of operative stabilisation following anterior shoulder dislocation in young versus elderly patients. Seventy-two patients with anterior shoulder dislocations were allocated into two groups. Group 1 (> 40 years of age) consisted of 23 patients, and group 2 (< 40 years of age) consisted of 49 patients. Operative stabilisation resulted in a significant reduction in recurrence rate in both groups. However, the clinical functional results measured by the Constant score, Rowe score and disabilities of the arm, shoulder and hand (DASH) score revealed significantly better outcomes in the younger (group 2) than in the older group (group 1). These results indicate that while operative stabilisation is equally effective in reducing recurrent shoulder dislocation in the elderly functional outcomes are not as good as in younger patients.

Role of lung contusions on posttraumatic inflammatory response and organ dysfunction in traumatized patients.

BACKGROUND: Multiple trauma is often accompanied by lung contusion leading to secondary pulmonary inflammation and organ dysfunction. The particular role of lung contusions on the systemic inflammatory response remains unclear. Therefore, the aim of the present study was to compare the degree of lung contusion with markers of inflammation and multiple organ failure (MOF) in trauma patients. METHODS: According to the Injury Severity Score (ISS), 45 patients were assigned to a low (< 25 points) and a high ISS group (> 25 points), respectively. Both groups were subdivided into minor and major lung injury groups as defined by computed tomography (CT) scan. Plasma levels of interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor (TNF) receptors, C-reactive protein (CRP), and polymorphonuclear (PMN) elastase were assessed, as well as the Murray lung score (MLS) and the MOF score. RESULTS: Patients with low ISS present moderate activation of inflammation which is not influenced by the degree of lung contusion. In contrast, patients with a high ISS develop significant posttraumatic inflammation and MOF. Patients with high ISS and severe lung contusions present significantly higher MLS and MOF scores. Interestingly, patients of the high ISS group without severe lung contusions develop a similar degree of MLS and MOF only after 5 days following the traumatic insult. However, the initial plasma levels of IL-6 and IL-8 differ significantly in this group. CONCLUSION: Our data show that severe lung contusions contributes to an immediate onset of posttraumatic inflammation in severely traumatized patients, resulting in MOF, while in severely injured patients without lung contusion, this development requires up to 5 days.

Altered gene expression patterns in dendritic cells after severe trauma: implications for systemic inflammation and organ injury.

Dendritic cells (DCs) are professional antigen-presenting cells and members of the adoptive immunity. In addition, they play an important role in innate immunity within the systemic inflammatory response to trauma and sepsis. In this study, gene expression patterns of DC in patients with multiple trauma were studied. Total RNA was isolated from highly purified DCs (purity>95%) that were enriched from peripheral blood mononuclear cells and whole blood, respectively. Samples were obtained from 10 multiple trauma patients (injury severity score, 35.4+/-10.6 on day of admission) and 5 healthy volunteers (control). Aliquots of target cDNAs and reference samples (cDNA derived from the monocytic cell line SIGM5) were cohybridized on a thematic medium-density microarray assessing 780 inflammation-related transcripts. Twenty transcripts were up-regulated in DCs of multiple trauma patients compared with healthy volunteers, whereas these differences were missed when RNA from whole blood was subjected to transcriptomic profiling. This cluster included central effector molecules of DC such as transcripts encoding for 5-lipoxygenase and the corresponding leukotriene 4 receptor, which regulate DC migration, adoptive immune responses, and airway inflammation, as well as CD74, CXCL4, or platelet factor 4, a chemokine not implicated as a product of DCs to date. In addition, genes involved in antiapoptosis (BCL2), intracellular signal transduction (mitogen-activated protein kinase), and secretion of mediators (VAMP2) were found to be up-regulated. The up-regulated transcripts suggest that life span and signaling function of DCs are altered by trauma. Furthermore, these data confirm and expand the central role of chemokines and lipid mediators as effector molecules of DC-mediated immune responses in systemic inflammation associated with severe trauma.

[Elastic stable intramedullary nailing of femur fractures in children]. / Die elastisch-stabile Marknagelung der Femurfraktur beim Kind.

OBJECTIVE: Elastic stable intramedullary nailing (ESIN) is a minimally invasive osteosynthesis technique that allows sufficient stabilization of fractures in children. INDICATIONS: The stabilization of femur fractures with ESIN is recommended for diapyseal femur fractures in children > or = 4 years until closure of the growth plates. CONTRAINDICATIONS: Open fractures with significant injuries to the soft tissues as well as burst fractures should not be treated with ESIN. SURGICAL TECHNIQUE: Small incisions are made medial and lateral of the femur just above the distal growth plate. The cortex is perforated with an awl. The first ESIN is pushed via this perforation intramedullary retrograde via the fracture site to the proximal femur near the trochanteric region. Afterwards, the second nail is passed through the opposite cortex of the distal femur after opening it in the same way. The second nail has to be pushed parallel retrograde via the fracture site into the contralateral trochanteric region. The flexible nail design enables the surgeon to fix the fracture via a three-point stabilization. POSTOPERATIVE MANAGEMENT: Postoperative mobilization is allowed on crutches with reduced weight depending on the type of fracture. According to the ESIN position transverse fractures allow an early switch toward full weight bearing, whereas in fractures with multiple fragments, weight bearing should be reduced for several weeks until radiologic healing is seen. RESULTS: The minimally invasive method of ESIN is a well-accepted treatment option for femur fracture in children yielding good and excellent clinical results. It is the treatment of first choice for transverse and oblique femoral fractures (32-D/4.1 und 32-D/5.1). Fractures with several fragments (32-D/5.2) as well as fractures of the metaphyseal region (31-M/3.1 und 33-M/3.1) may be difficult to stabilize with ESIN and might alternatively be treated with an external fixator.

Prehospital ultrasound detects pericardial tamponade in a pregnant victim of stabbing assault.

The development of handheld, portable ultrasound devices has enabled the use of this diagnostic tool also in the out-of-hospital environment. We report on a pregnant teenager who was found haemodynamically unstable after a stab assault. When she suffered cardiac arrest shortly thereafter, diagnosis of cardiac tamponade was made by portable ultrasound, and immediate pericardiocentesis was performed by the emergency physician. While her baby died after emergency Caesarean section, the teenager survived after thoracotomy and prolonged resuscitation without neurological sequelae.

Perioperative Application of a Serum Protein Solution (Biseko(®)) After Proximal Femur Fracture of Elder Patients.

Fractures of the proximal femur are frequently seen in elderly people and will increase due to the demographic development of most industrialized countries. Early operation of dislocated fractures with either osteosynthesis or hemiprothesis has become a standard treatment for this type of injury. The high co-morbidity often leads to secondary complications like infections still resulting in a perioperative mortality rate of 11%. The perioperative infusion regime might influence the postoperative inflammatory response. Therefore Biseko(®), a serum protein solution, was compared to albumin and crystalloid infusion (Elomel). A total of 45 patients with proximal femur fractures were randomly assigned to either of the groups and received 500 ml of the infusion on 3 days starting from the day of operation. The Biseko(®) group showed significantly lower CRP levels, less infections and antibiotic treatment as well as a better clinical outcome referring to the TISS28 and APACHE Score. Concerning IL-6, IL-8, IL-10 and serum leukocytes no significant differences were observed. The result shows a beneficial influence of the serum protein solution Biseko(®) concerning the number of perioperative complications. The design of this study and the small number of patients does not yet allow any conclusion concerning the effectiveness of this treatment.

Fracture and retrosternal dislocation of the medial clavicle in a 12-year-old child--case report, options for diagnosis, and treatment in children.

We report a retrosternally displaced epiphysiolysis in a 12-year-old child and discuss options for the most appropriate diagnostic and therapeutic approach. If a standard anteroposterior view of the shoulder girdle shows abnormalities or if appropriate clinical suspicion is present, we strongly favor an magnetic resonance imaging study for further workup instead of a computed tomographic scan, which is currently the diagnostic method of choice in clinical algorithms. Radiation exposure is thereby limited and maximum information about possible mediastinal soft tissue complications is obtained using a single diagnostic tool. If open reduction is indicated, retention of the joint or approximation of physeal fracture or treatment of ligamentous injury should be performed without metal devices. These suggestions for future management of these patients should further reduce the use of x-rays in children. In addition, applying a suture instead of using metal for stabilization can avoid the extensively described complications in literature that can potentially result from metal devices. In addition, sutures circumvent the need for a second operation for metal removal.

Attenuation of leukocyte adhesion by recombinant TNF-binding protein after hemorrhagic shock in the rat.

Ischemia/reperfusion injury involves a large number of humoral and cellular mediators that activate leukocytes that subsequently migrate to local tissues. Tumor necrosis factor (TNF)-alpha may be one of the most important mediators of this post-shock inflammatory response. In this study, we investigated the influence of a recombinant Type I (55 kDa) TNF-binding protein (TNF-BP) on leukocyte-endothelial interactions in the liver after hemorrhagic shock. Hemorrhagic shock was induced in female Sprague-Dawley rats (40 mmHg for 90 min) and a standardized resuscitation regimen was applied. At the time of resuscitation, animals were treated intravenously with either TNF-BP 4 mg/kg or placebo. The liver microcirculation was investigated using intravital fluorescence microscopy and immunohistochemistry at 5 h and 48 h after reperfusion. At 5 h, treatment with TNF-BP significantly reduced temporary leukocyte adhesion in the liver sinusoids as well as mean adhesion time of leukocytes in the hepatic central vein. In contrast, after 48 h, permanent leukocyte adhesion in the central hepatic vein was significantly reduced in the group receiving TNF-BP, whereas temporary leukocyte adhesion and mean adhesion time did not differ between the two groups. Both types of leukocyte adhesion, rolling adhesion after 5 h and firm adhesion after 48 h, were reduced in the group treated with TNF-BP, thereby suggesting a long-lasting anti-inflammatory effect.