How the trauma center in the US is managed is not fully understood by the majority of Japanese trauma surgeons and emergency physicians. I visited seven major trauma centers throughout the US, in 2002. I observed the PIPS program of each trauma center and interviewed the Trauma Medical Directors and the Trauma Program Managers about how they manage their trauma centers. In this article, I described the purpose of the PIPS program and how it should be managed. The trauma centers are verified by the American College of Surgeons-Committee on Trauma based on "Resources for Optimal Care of the Injured Patient" and designated by the government of each State. The PIPS program is a major component of the trauma program and every trauma center should have appropriate human resources and organized committees in charge of quality improvement. The trauma registry is a key tool in the PIPS program, and much effort in maintaining the quality of data input is necessary. The cost of maintaining the trauma registry is large, and there is no subsidization from the state government. Maintaining the designation as a trauma center is very important in terms of hospital financing.

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　　Phospholipase A₂ (PLA₂) is an essential enzyme regulating inflammatory processes. However, the relationship between calcium-independent PLA₂ and acute inflammation remains unclear. The cytotoxicity of mesenteric lymph is one of the pathogenic mechanisms of multiple organ failure following hemorrhagic shock. We have identified biologically active lysophospholipids with unsaturated fatty acids that are elaborated through the activation of iPLA₂γ. In addition, we have demonstrated that iPLA₂γ may be involved in multiple PMN cytotoxic functions (respiratory burst, degranulation, chemotaxis, adherence, and surface expression of adhesion molecules) as well as the adherence cascade in the mesenteric microcirculation. Taken together, it is likely that the iPLA₂γ enzyme plays crucial roles in acute inflammatory conditions.

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