KASMEJ

Kastamonu Medical Journal regularly publishes internationally qualified issues in the field of Medicine in the light of up-to-date information.

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Original Article
Determine the relationship between the severity of trauma and plasma amino acid levels in patients presenting to the emergency department after isolated thoracic trauma
Aims: Trauma represents a significant health concern that can affect individuals across the lifespan. To anticipate the outcomes of thoracic trauma, a chest trauma severity score (TTSS) has been established for use in patients presenting with traumatic injuries. The relationship between TTSS and amino acid (aa) levels in patients remains to be elucidated.
Methods: The current study included a prospective cohort of 35 patients presenting to the emergency department with isolated thoracic trauma between October 2022 and October 2023. A control group of 35 individuals with similar age and gender characteristics was also included. The TTSS of the patient group was calculated at the time of presentation. The alterations in amino acid levels associated with TTSS were assessed in the blood samples obtained from the patient and control groups.
Results: Serum arginine levels of patients with isolated thoracic trauma exhibited a lower correlation at the time of initial presentation compared to the control group. However, at 48 hours, these levels were observed to be higher (p<0.044, p<0.040). The serum levels of glycine and taurine amino acids were observed to be higher in the initial presentation of patients compared to the control group (p<0.041, p<0.016). A total of 35 patients admitted to the emergency department with isolated thoracic trauma between October 2022 and October 2023 and 35 control groups with similar age and gender were prospectively included in the study. The TTSS of the patient group was calculated at the time of presentation, and changes in TTSS-related amino acid levels were evaluated in blood samples taken from the patient and control groups.
Conclusion: It is hypothesised that the determination of amino acid levels, including arginine, glycine and taurine, and the replacement of absent values will facilitate the recuperation of patients, enhancing vital functions following trauma and reducing or eliminating mortality.


1. Mackenzie EJ, Fowler C. Epidemiology of trauma. In: Mattox KJ, Feliciano DV, Moore EE, eds. Trauma. 5th ed. Stamford, CT: Appleton and Lange; 2004:21-39.
2. Santos GH. Chest trauma during the battle of Troy: ancient warfare and chest trauma. Ann Thorac Surg. 2000;69(4):1285-1287. doi:10.1016/s0003-4975(00)01158-9
3. Cameron P, Knapp BJ. Trauma in Adults. In: Tintinalli JE, Ma OJ, Yealy DM, Meckler GD, Cline DM, eds. Tintinalli&rsquo;s Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw Hill Education; 2016:1681-1688.
4. Demetriades D, Kimbrell B, Salim A, et al. Trauma deaths in a mature urban trauma system: is &ldquo;trimodal&rdquo; distribution a valid concept? J Am Coll Surg. 2005;201(3):343-348. doi:10.1016/j.jamcollsurg.2005.05.003
5. Demetriades D, Murray J, Charalambides K, et al. Trauma fatalities: time and location of hospital deaths. J Am Coll Surg. 2004;198(1):20-26. doi:10.1016/j.jamcollsurg.2003.09.003
6. Sanchez GM, Meltzer ES. The Edwin Smith Papyrus: Updated Translation of the Trauma Treatise and Modern Medical Commentaries.
7. Hildebrand F, van Griensven M, Garapati R, Krettek C, Pape HC. Diagnostics and scoring in blunt chest trauma. Eur J Trauma. 2002;28(3): 157-167. doi:10.1007/s00068-002-1192-1
8. Kanake V, Kale K, Mangam S, Bhalavi V. Thorax trauma severity score in patient with chest trauma: study at tertiary-level hospital. Indian J Thorac Cardiovasc Surg. 2022;38(2):149-156. doi:10.1007/s12055-021-01312-z
9. Wu G. Amino acids: metabolism, functions, and nutrition. Amino Acids. 2009;37(1):1-17. doi:10.1007/s00726-009-0269-0
10. Shimomura Y, Kitaura Y, Kadota Y, et al. Novel physiological functions of branched-chain amino acids. J Nutr Sci Vitaminol. 2015;61(Suppl): S112-S114. doi:10.3177/jnsv.61.S112
11. Brosnan JT. Interorgan amino acid transport and its regulation. J Nutr. 2003;133(6 Suppl 1):2068S-2072S. doi:10.1093/jn/133.6.2068S
12. Stolarski AE, Young L, Weinberg J, et al. Early metabolic support for critically ill trauma patients: a prospective randomized controlled trial. J Trauma Acute Care Surg. 2022;92(2):255-265. doi:10.1097/TA. 0000000000003453
13. Hasselgren PO, Pedersen P, Sax HC, Warner BW, Fischer JE. Current concepts of protein turnover and amino acid transport in liver and skeletal muscle during sepsis. Arch Surg. 1988;123(8):992-999. doi:10. 1001/archsurg.1988.01400320078016
14. Grecos GP, Abbott WC, Schiller WR, et al. The effect of major thermal injury and carbohydrate-free intake on serum triglycerides, insulin, and 3-methylhistidine excretion. Ann Surg. 1984;200(5):632-637. doi:10. 1097/00000658-198411000-00013
15. Chaudry IH, Ayala A. Immunological Aspects of Hemorrhage. Austin, TX: Medical Intelligence Unit, RG Landes; 1992:1-132.
16. Ayala A, Perrin MM, Wagner MA, Chaudry IH. Enhanced susceptibility to sepsis after simple hemorrhage: depression of Fc and C3b receptor-mediated phagocytosis. Arch Surg. 1990;125(1):70-75. doi:10.1001/archsurg.1990.01410130076010
17. Zellweger R, Ayala A, DeMaso CM, Chaudry IH. Trauma-hemorrhage causes prolonged depression in cellular immunity. Shock. 1995;4(2):149-153. doi:10.1097/00024382-199508000-00012
18. Angele MK, Smail N, Wang P, et al. L-arginine restores the depressed cardiac output and regional perfusion after trauma-hemorrhage. Surgery. 1998;124(2):394-402.
19. Peranzoni E, Marigo I, Dolcetti L, et al. Role of arginine metabolism in immunity and immunopathology.Immunobiology. 2008;212(9-10):795-812. doi:10.1016/j.imbio.2007.09.008
20. Angele MK, Nitsch SM, Hatz RA, et al. L-arginine: a unique amino acid for improving depressed wound immune function following hemorrhage. Eur Surg Res. 2002;34(1-2):53-60. doi:10.1159/000048888
21. Karhadkar S, Barbul A. Is it important to deliver enhanced levels of arginine to critically ill patients? In: Evidence-Based Practice of Critical Care. 2010:457-460.
22. Qualls JE, Neale G, Smith AM, et al. Arginine usage in mycobacteria-infected macrophages depends on autocrine-paracrine cytokine signaling. Sci Signal. 2010;3(135):ra62. doi:10.1126/scisignal.2000955
23. Quirino IEP, Carneiro MBH, Cardoso VN, et al. Arginine supplementation induces arginase activity and inhibits TNF-&alpha; synthesis in mice spleen macrophages after intestinal obstruction. JPEN J Parenter Enteral Nutr. 2016;40(3):417-422. doi:10.1177/0148607114546374
24. Yang S, Koo DJ, Chaudry IH, Wang P. Glycine attenuates hepatocellular depression during early sepsis and reduces sepsis-induced mortality. Crit Care Med. 2001;29(6):1201-1206. doi:10.1097/00003246-200106000-00024
25. Lee MA, McCauley RD, Kong SE, Hall JC. Influence of glycine on intestinal ischemia-reperfusion injury. JPEN J Parenter Enteral Nutr. 2002;26(2):130-135. doi:10.1177/0148607102026002130
26. Rivera CA, Bradford BU, Hunt KJ, et al. Attenuation of CCl4-induced hepatic fibrosis by GdCl3 treatment or dietary glycine. Am J Physiol Gastrointest Liver Physiol. 2001;281(1):G200-G207. doi:10.1152/ajpgi. 2001.281.1.G200
27. Li X, Bradford BU, Wheeler MD, et al. Dietary glycine prevents peptidoglycan polysaccharide-induced reactive arthritis in the rat: role for glycine-gated chloride channel. Infect Immun. 2001;69(9):5883-5891. doi:10.1128/IAI.69.9.5883-5891.2001
28. Reichelt WH, Yndestad A, Wright MS, Elgjo K, Haug T, Reichelt KL. The colon mitosis-inhibitor pyroglutamyl-histidyl-glycine alters expression of immediate-early cancer-related genes in HT-29 cells. Anticancer Res. 2003;23(2B):1229-1234.
29. Bhan MK, Sazawal S, Bhatnagar S, et al. Glycine, glycyl-glycine and maltodextrin based oral rehydration solution assessment of efficacy and safety in comparison to standard ORS. Acta Paediatr. 1990;79(5):518-526. doi:10.1111/j.1651-2227.1990.tb11506.x
30. Truong DD, Fahn S. Therapeutic trial with glycine in myoclonus. Mov Disord. 1988;3(3):222-232. doi:10.1002/mds.870030306
31. Patel DK, Ogunbona A, Notarianni LJ, Bennett PN. Depletion of plasma glycine and effect of glycine by mouth on salicylate metabolism during aspirin overdose. Hum Exp Toxicol. 1990;9(6):389-395. doi:10. 1177/096032719000900606
32. Zhao W, Jia L, Yang HJ, et al. Taurine enhances the protective effect of dexmedetomidine on sepsis-induced acute lung injury via balancing the immunological system. Biomed Pharmacother. 2018;103:1362-1368. doi:10.1016/j.biopha.2018.04.150
33. Li S, Wang J, Wei BK, et al. Protective effect of taurine on paraquat-induced lung epithelial cell injury. In: Taurine 11. Springer Singapore; 2019:739-746.
34. Su Y, Fan W, Ma Z, et al. Taurine improves functional and histological outcomes and reduces inflammation in traumatic brain injury. Neuroscience. 2014;266:56-65. doi:10.1016/j.neuroscience.2014.02.006
35. Abdih H, Kelly CJ, Bouchier-Hayes D, Barry M, Kearns S. Taurine prevents interleukin-2-induced acute lung injury in rats. Eur Surg Res. 2000;32(6):347-52. doi:10.1159/000052216
36. Men X, Han S, Gao J, et al. Taurine protects against lung damage following limb ischemia reperfusion in the rat by attenuating endoplasmic reticulum stress-induced apoptosis. Acta Orthop. 2010; 81(2):263-267. doi:10.3109/17453671003587085
Volume 5, Issue 4, 2025
Page : 221-226
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