Objective： To study the effect and indications ofintracranial pressure （ICP） monitoring for frontal lobe contusion patients. Methods： During January 2005-December 2008, 34 cases of frontal lobe contusion received ...Objective： To study the effect and indications ofintracranial pressure （ICP） monitoring for frontal lobe contusion patients. Methods： During January 2005-December 2008, 34 cases of frontal lobe contusion received ICP monitoring in our department （monitoring group）. Different treatment protocols were adopted according to the results of ICP. Mean-while 46 cases of same type of head-injured patients who did not undergo ICP monitoring served as control group. Results： We found that ICP elevated dramatically within 24 hours after head injury if the contusions were located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or dispersed in bilateral lobe. After half a year follow-up and on the basis of Glasgow Coma Scale assessment, the monitoring group showed better outcome than the control group with good recovery in 24 cases （70.6%）, moderate disability in 7 cases （20.6%）, severe disability in 2 （5.88%） and death in 1 （2.94%）. The outcome of control group displayed good condition in 25 cases （54.3%）, moderate disabilities in 8 （17.4%）, severe disability in 7 （15.2%）, and death in 6 （13.0%）. Conclusions： Frontal lobe contusions are vulnerable and complex head injuries, especially when the contusions are located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or diffused in bilateral lobes. These patients should undergo ICP monitoring regardless of their consciousness status. IflCP elevates over 25 mm Hg, the craniotomy is mandatory and will markedly reduce the mortality and disability of these patients.展开更多
Backgroud:Thoracic Trauma and Limb Fractures Are the Two most Common Injuries in Multiple Trauma.However,there Is Still a Lack of Mouse Models of Trauma Combining Tibial Shaft Fracture(TSF)and Thoracic Trauma.In this ...Backgroud:Thoracic Trauma and Limb Fractures Are the Two most Common Injuries in Multiple Trauma.However,there Is Still a Lack of Mouse Models of Trauma Combining Tibial Shaft Fracture(TSF)and Thoracic Trauma.In this Study,we Attempted to Develop a Novel Mouse Model of TSF Combined with Blunt Chest Trauma(BCT).Methods:A total of 84 C57BL/6J male mice were used as the multiple trauma model.BCT was induced by hitting the chests of mice with heavy objects,and TSF was in-duced by hitting the tibia of mice with heavy objects after intramedullary fixation.Serum specimens of mice were received by cardiac puncture at defined time points of 0,6,12,24,48,and 72 h.Results:Body weight and body temperature tended to decrease within 24 h after mul-tiple trauma.Hemoglobin analyses revealed a decrease during the first 24 h after mul-tiple trauma.Some animals died by cardiac puncture immediately after chest trauma.These animals exhibited the most severe pulmonary contusion and hemorrhage.The level of lung damage varied in diverse mice but was apparent in all animals.Classic he-matoxylin and eosin(H&E)-stained paraffin pulmonary sections of mice with multiple trauma displayed hemorrhage and an immunoinflammatory reaction.Bronchoalveolar lavage fluid(BALF)and serum samples of mice with multiple trauma showed an upreg-ulation of interleukin-1β(IL-1β),IL-6,and tumor necrosis factor-1α(TNF-1α)compared with the control group.Microimaging confirmed the presence of a tibia fracture and pulmonary contusion.Conclusions:The novel mouse multiple trauma model established in this study is a common trauma model that shows similar pathological mechanisms and imaging characteristics in patients with multiple injuries.This study is useful for determining whether blockade or intervention of the cytokine response is beneficial for the treat-ment of patients with multiple trauma.Further research is needed in the future.展开更多
Introduction: Traumatic Brain Injury (TBI) is a major public health problem causing significant morbidity and mortality in young adults. This study aimed to describe the epidemiological, diagnostic, therapeutic, and e...Introduction: Traumatic Brain Injury (TBI) is a major public health problem causing significant morbidity and mortality in young adults. This study aimed to describe the epidemiological, diagnostic, therapeutic, and evolutionary aspects of TBI. Materials and Methods: This was a prospective, descriptive study conducted from 1 April 2022 to 31 March 2023 on patients admitted to and treated for cranioencephalic trauma in the General Surgery department of Kara Regional Hospital. Results: Eighty-three (83) patients with cranioencephalic trauma were managed out of 773 patients admitted to the department during the study period. The mean age was 34 ± 14.98 years and the sex ratio was 3.6 in favour of men. Motorbike taxi drivers were the social group most affected (n = 33, 40%). The causes of trauma were dominated by public road accidents (n = 80;96%). TBI was mild (n = 40;48%), moderate (n = 35;42%) and severe (n = 8;10%). Cerebral CT scans were performed in 19 patients (23%). Cerebral contusion (n = 4) was the most frequent cerebral lesion. Six patients (7%) with severe head injuries were transferred to Kara University Hospital. Six deaths (7%) occurred in patients with severe head injuries. The main sequelae were intermittent headaches in all patients reviewed, and memory problems (6%). Conclusion: Traumatic brain injuries are common at Kara Regional Hospital. Severe cranial trauma is less frequent but leads to death because of financial difficulties and limited technical facilities.展开更多
OBJECTIVE： To investigate the curative effects of Xuebijing （XBJ） injection, a Chinese patent medi- cine, on severe pulmonary contusion （PC）. METHODS： Sixty-three patients with PC were ran- domized to convention...OBJECTIVE： To investigate the curative effects of Xuebijing （XBJ） injection, a Chinese patent medi- cine, on severe pulmonary contusion （PC）. METHODS： Sixty-three patients with PC were ran- domized to conventional therapy plus XBJ injec- tion （n=33） or conventional therapy alone （n=30）. Between groups differences in corticosteroid treat- ment, immune regulation therapy, hemofiltration, infusion volume, transfusion volume and antibiotic period were measured, as were intensive care unit（ICU）-free time, ventilation time, 28-day mortality rate and incidence of ventilation-associated pneu- monia （VAP）. Serum concentrations of procalcito- nin （PCT）, tumor necrosis factor-a （TNF-a）, interleu- kin （IL）-6, and 11_-10, white blood cell （WBC） counts and percentages of human leukocyte antigen DR/ CD14＋ （HLA-DR/CD14＋） peripheral blood mononu- clear cells were compared. Markers of ventilation were determined by blood gas analysis and ventila- tor parameters. RESULTS： WBC counts and serum concentrations of PCT, TNF-a, 11.-6 and IL-10 were reduced signifi- cantly more quickly, and CD14＋ percentage was in- creased significantly earlier, in the XBJ group than in the control group （P〈0.05 each）. The level of ven- tilation and oxygenation index were ameliorated earlier in the XBJ than in the control group （P〈 0.05）. XBJ treatment significantly reduced ICU-free time, ventilation time and incidence of VAP （P〈0.05 each）, but had no effect on 28-day mortality rate （P〉0.05）. CONCLUSION： XBJ treatment can shorten ICU-free and ventilation times and reduce the incidence of VAP, improving outcomes in patients with severe PC. XBJ may act by regulating inflammation and im- munity, alleviating systemic inflammatory response syndrome induced by trauma.展开更多
Hypothalamic-pituitary-adrenal axis dysfunction may lead to the occurrence of critical illness-related corticosteroid insufficiency.Critical illness-related corticosteroid insufficiency can easily occur after traumati...Hypothalamic-pituitary-adrenal axis dysfunction may lead to the occurrence of critical illness-related corticosteroid insufficiency.Critical illness-related corticosteroid insufficiency can easily occur after traumatic brain injury,but few studies have examined this occurrence.A multicenter,prospective,cohort study was performed to evaluate the function of the hypothalamic-pituitary-adrenal axis and the incidence of critical illness-related corticosteroid insufficiency during the sub-acute phase of traumatic brain injury.One hundred and forty patients with acute traumatic brain injury were enrolled from the neurosurgical departments of three tertiary-level hospitals in China,and the critical illness-related corticosteroid insufficiency incidence,critical-illness-related corticosteroid insufficiency-related risk factors,complications,and 28-day mortality among these patients was recorded.Critical illness-related corticosteroid insufficiency was diagnosed in patients with plasma total cortisol levels less than 10μg/dL(275.9 nM)on post-injury day 4 or when serum cortisol was insufficiently suppressed(less than 50%)during a dexamethasone suppression test on post-injury day 5.The results demonstrated that critical illness-related corticosteroid insufficiency occurred during the sub-acute phase of traumatic brain injury in 5.6%of patients with mild injury,22.5%of patients with moderate injury,and 52.2%of patients with severe injury.Traumatic brain injury-induced critical illness-related corticosteroid insufficiency was strongly correlated to injury severity during the sub-acute stage of traumatic brain injury.Traumatic brain injury patients with critical illness-related corticosteroid insufficiency frequently presented with hemorrhagic cerebral contusions,diffuse axonal injury,brain herniation,and hypotension.Differences in the incidence of hospital-acquired pneumonia,gastrointestinal bleeding,and 28-day mortality were observed between patients with and without critical illness-related corticosteroid insufficiency during the sub-acute phase of traumatic brain injury.Hypotension,brain-injury severity,and the types of traumatic brain injury were independent risk factors for traumatic brain injury-induced critical illness-related corticosteroid insufficiency.These findings indicate that critical illness-related corticosteroid insufficiency is common during the sub-acute phase of traumatic brain injury and is strongly associated with poor prognosis.The dexamethasone suppression test is a practical assay for the evaluation of hypothalamic-pituitary-adrenal axis function and for the diagnosis of critical illness-related corticosteroid insufficiency in patients with traumatic brain injury,especially those with hypotension,hemorrhagic cerebral contusions,diffuse axonal injury,and brain herniation.Sub-acute infection of acute traumatic brain injury may be an important factor associated with the occurrence and development of critical illness-related corticosteroid insufficiency.This study protocol was approved by the Ethics Committee of General Hospital of Tianjin Medical University,China in December 2011(approval No.201189).展开更多
Graphene and graphene-based materials have the ability to induce stem cells to differentiate into neurons,which is necessary to overcome the current problems faced in the clinical treatment of spinal cord injury.This ...Graphene and graphene-based materials have the ability to induce stem cells to differentiate into neurons,which is necessary to overcome the current problems faced in the clinical treatment of spinal cord injury.This review summarizes the advantages of graphene and graphene-based materials(in particular,composite materials)in axonal repair after spinal cord injury.These materials have good histocompatibility,and mechanical and adsorption properties that can be targeted to improve the environment of axonal regeneration.They also have good conductivity,which allows them to make full use of electrical nerve signal stimulation in spinal cord tissue to promote axonal regeneration.Furthermore,they can be used as carriers of seed cells,trophic factors,and drugs in nerve tissue engineering scaffolds to provide a basis for constructing a local microenvironment after spinal cord injury.However,to achieve clinical adoption of graphene and graphene-based materials for the repair of spinal cord injury,further research is needed to reduce their toxicity.展开更多
BACKGROUND： Pattern- visual evoked potential （PVEP） can reflect the functional status of retinal ganglial cells （RGC） and visual cortex, and is an objective examination for visual pathway function. It is a unique...BACKGROUND： Pattern- visual evoked potential （PVEP） can reflect the functional status of retinal ganglial cells （RGC） and visual cortex, and is an objective examination for visual pathway function. It is a unique method for objectively examining the optic nerve function of optic ganglion cells. OBJECTIVE： To observe the effects of nerve growth factor （NGF） on PVEF in the treatment of optic nerve contusion, evaluate the clinical efficacy of NGF, and make an efficacy comparison with vitamin B12. DESIGN： A randomly grouping, controlled observation. SETTING： Department of Ophthalmology, Tangshan Gongren Hospital Affiliated to Hebei Medical University. PARTICIPANTS： Forty patients with optic nerve contusion caused by eye trauma, who received the treatment in the Tangshan Worker Hospital Affiliated to Hebei Medical University between January 2006 and June 2007, were recruited in this study. The involved 40 patients, including 34 males and 6 females, were aged 14-59 years. They were confirmed to have optic nerve contusion by ophthalmologic consultation combined with history of disease and orbital CT examination. Informed consents of treatments and detected items were obtained from all the patients. The patients were randomly divided into 2 groups with 20 in each： NGF group and vitamin B12 group. METHODS： Conservative treatment was used in the two groups. In addition, patients in the NGF group were intramuscularly injected with NGF solution 18 μg /time, once a day. Those in the vitamin B12 group were injected by the same method with common vitamin B12 of 500 μg combined with vitamin B1 of 100 mg, once a day. MAIN OUTCOME MEASURES： PVEP examination was conducted in all the patients before, one and two weeks after treatment, and latency and amplitude at P100 were detected. RESULTS： Forty patients with optic nerve contusion participated in the final analysis. Before treatment, significant differences in the latency and amplitude at P100 were not found in patients between two groups （P 〉 0.05）. For each patient in the NGF group, the latency of PVEP at P100 was significantly shortened, and the amplitude was significantly increased one and two weeks after treatment as compared with vitamin B12 group（t =2.06-2.34, P 〈 0.05）. CONCLUSION： NGF treatment can obviously improve the visual function of patients with optic nerve contusion. The curative effect of NGF is superior to vitamin B12.展开更多
OBJECTIVE: To investigate the effects of Gyejibokryeong-Hwan(Guizhifuling-wan, GBH) on muscle injury in a mouse model of muscle contusion.METHODS: C57/BL6 mouse biceps femoris muscles were injured using the drop-mass ...OBJECTIVE: To investigate the effects of Gyejibokryeong-Hwan(Guizhifuling-wan, GBH) on muscle injury in a mouse model of muscle contusion.METHODS: C57/BL6 mouse biceps femoris muscles were injured using the drop-mass method and injured animals were treated orally with GBH(50,100, or 500 mg/kg) once a day for 7 d. Open field and treadmill running tests were performed to assess functional recovery from muscle injury. The production of pro-inflammatory cytokines was examined by enzyme-linked immunosorbent assay and Western blotting analysis. Expression of the muscle regeneration biomarkers, myoblast determination(Myo D), myogenic factor 5(Myf5), and smooth muscle actin(α-SMA), in the biceps femoris muscle was investigated at the protein and m RNA level by Western blotting and real time-PCR, respectively. Histological analysis was performed using hematoxylin and eosin staining. Finally, myosin heavy chain production was investigated in differentiated C2C12 myoblasts in the presence of GBH.RESULTS: GBH treatment markedly improved locomotion and running behavior. GBH significantly inhibited the secretion of monocyte chemoattractant protein-1 into the bloodstream in muscle-contused animals. The levels of Myo D, Myf5, and α-SMA protein and m RNA were significantly up-regulated by GBH in injured muscle tissue. Histological studies suggested that GBH facilitated recovery from muscle damage. However, GBH did not induce the production of myosin heavy chain in vitro.CONCLUSION: Overall, the present study suggested that GBH improves the recovery of the injured muscles in the mouse model of muscle contusion.展开更多
Blast-induced traumatic brain injury(b-TBI)is a kind of significant injury to soldiers in the current military conflicts.However,the mechanism of b-TBI has not been well understood,and even there are some contradictor...Blast-induced traumatic brain injury(b-TBI)is a kind of significant injury to soldiers in the current military conflicts.However,the mechanism of b-TBI has not been well understood,and even there are some contradictory conclusions.It is crucial to reveal the dynamic mechanism of brain volume and shear deformations under blast loading for better understanding of b-TBI.In this paper,the numerical simulation method is adopted to carry out comprehensive and in-depth researches on this issue for the first time.Based on the coupled Eulerian-Lagrangian method,the fluid-structure coupling model of the blast wave and human head is developed to simulate two situations,namely the head subjected to the frontal and lateral impacts.The simulation results are analyzed to obtain the underlying dynamic mechanisms of brain deformation.The brain volume deformation is dominated by the local bending vibration of the skull,and the corresponding frequency for the forehead skull under the frontal impact and the lateral skull faced to the lateral impact is as high as 8 kHz and 5 kHz,respectively.This leads to the high-frequency fluctuation of brain pressure and the large pressure gradient along the skull,totally different from the dynamic response of brain under head collisions.While the brain shear deformation mainly depends on the relative tangential displacement between the skull and brain and the anatomical structure of inner skull,being not related to the brain pressure and its gradient.By further comparing the medical statistics,it is inferred that diffuse axonal injury and brain contusion,the two most common types of b-TBI,are mainly attributed to brain shear deformations.And the von Mises stress can be adopted as the indicator for these two brain injuries.This study can provide theoretical guidance for the diagnosis of b-TBI and the development of protective equipment.展开更多
The mechanism involved in neural regeneration after spinal cord injury is unclear. The my-elin-derived protein Nogo-A, which is speciifc to the central nervous system, has been identiifed to negatively affect the cyto...The mechanism involved in neural regeneration after spinal cord injury is unclear. The my-elin-derived protein Nogo-A, which is speciifc to the central nervous system, has been identiifed to negatively affect the cytoskeleton and growth program of axotomized neurons. Studies have shown that Nogo-A exerts immediate and chronic inhibitory effects on neurite outgrowth.In vivo, inhibitors of Nogo-A have been shown to lead to a marked enhancement of regenerative axon extension. We established a spinal cord injury model in rats using a free-falling weight drop device to subsequently investigate Nogo-A expression. Nogo-A mRNA and protein expression and immunoreactivity were detected in spinal cord tissue using real-time quantitative PCR, immu-nohistochemistry and western blot analysis. At 24 hours after spinal cord injury, Nogo-A protein and mRNA expression was low in the injured group compared with control and sham-operated groups. The levels then continued to drop further and were at their lowest at 3 days, rapidly rose to a peak after 7 days, and then gradually declined again after 14 days. These changes were observed at both the mRNA and protein level. The transient decrease observed early after injury followed by high levels for a few days indicates Nogo-A expression is time dependent. This may contribute to the lack of regeneration in the central nervous system after spinal cord injury. The dynamic varia-tion of Nogo-A should be taken into account in the treatment of spinal cord injury.展开更多
Traumatic spinal cord injury （SCI） is a detrimental condition that causes loss of sensory and motor function in an individual. Many complex secondary injury cascades occur after SCI and they offer great potential fo...Traumatic spinal cord injury （SCI） is a detrimental condition that causes loss of sensory and motor function in an individual. Many complex secondary injury cascades occur after SCI and they offer great potential for therapeutic targeting. In this study, we investigated the response of endogenous neural progenitor cells, astrocytes, and microglia to a localized thoracic SCI throughout the neuroaxis. Twenty-five adult female Sprague-Dawley rats underwent mild-contusion thoracic SCI （n = 9）, sham surgery （n = 8）, or no surgery （n = 8）. Spinal cord and brain tissues were fixed and cut at six regions of the neuroaxis. Immunohistochem- istry showed increased reactivity of neural progenitor cell marker nestin in the central canal at all levels of the spinal cord. Increased reactivity of astrocyte-specific marker glial fibrillary acidic protein was found only at the lesion epicenter. The number of activated microglia was significantly increased at the lesion site, and activated microglia extended to the lumbar enlargement. Phagocytic microglia and macrophages were significantly increased only at the lesion site. There were no changes in nestin, glial fibrillary acidic protein, microglia and macrophage response in the third ventricle of rats subjected to mild-contusion thoracic SCI compared to the sham surgery or no surgery. These findings indicate that neural progenitor cells, astrocytes and microglia respond differently to a localized SCI, presumably due to differences in inflammatory signaling. These different cellular responses may have implications in the way that neural progenitor cells can be manipulated for neuroregeneration after SCI. This needs to be further investigated.展开更多
With advances in genetic and imaging techniques, investigating axon regeneration after spinal cord injury in vivo is becoming more common in the literature. However, there are many issues to consider when using animal...With advances in genetic and imaging techniques, investigating axon regeneration after spinal cord injury in vivo is becoming more common in the literature. However, there are many issues to consider when using animal models of axon regeneration, including species, strains and injury models. No single particular model suits all types of experiments and each hypothesis being tested requires careful selection of the appropriate animal model. In this review, we describe several commonly-used animal models of axon regeneration in the spinal cord and discuss their advantages and disadvantages.展开更多
Contusion spinal cord injury(SCI)is a major medical and socio-economic problem globally.The incidence of SCI is highest among young adults due to motor vehicle accidents,military or sports injuries,and violence(Selvar...Contusion spinal cord injury(SCI)is a major medical and socio-economic problem globally.The incidence of SCI is highest among young adults due to motor vehicle accidents,military or sports injuries,and violence(Selvarajah et al.,2014).The elderly and children are also at risk due to falls and accidents.SCI causes neurodegeneration,with profound loss of locomotor and sensory functions(Siddiqui et al.,2015).Pain and depression are also prevalent in a majority of SCI patients.Expenses for severe SCI are high:initial hospitalization,rehabilitation,and most likely the continuing need for a caregiver and medical care.SCI survivors with less severe injuries usually face lower but still hefty medical bills.However,people≥50 years old with severe SCI may face medical expenses of over$1.8 million during their lifetimes.These injuries also affect spouses and family members,emotionally and financially,and most injuries jeopardize employment for those affected.展开更多
Spinal cord injury is a major cause of disability with devastating neurological outcomes and lim-ited therapeutic opportunities, even though there are thousands of publications on spinal cord injury annually. There ar...Spinal cord injury is a major cause of disability with devastating neurological outcomes and lim-ited therapeutic opportunities, even though there are thousands of publications on spinal cord injury annually. There are two major types of spinal cord injury, transaction of the spinal cord and spinal cord contusion. Both can theoretically be treated, but there is no well documented treatment in human being. As for spinal cord contusion, we have developed an operation with fabulous result.展开更多
This study aimed to investigate aquaporin 4 expression and the ultrastructure of the blood-brain barrier at 2-72 hours following cerebral contusion injury, and correlate these changes to the formation of brain edema. ...This study aimed to investigate aquaporin 4 expression and the ultrastructure of the blood-brain barrier at 2-72 hours following cerebral contusion injury, and correlate these changes to the formation of brain edema. Results revealed that at 2 hours after cerebral contusion and laceration injury, aquaporin 4 expression significantly increased, brain water content and blood-brain barrier permeability increased, and the number of pinocytotic vesicles in cerebral microvascular endothelia cells increased. In addition, the mitochondrial accumulation was observed. As contusion and laceration injury became aggravated, aquaporin 4 expression continued to increase, brain water content and blood-brain barrier permeability gradually increased, brain capillary endothelial cells and astrocytes swelled, and capillary basement membrane injury gradually increased. The above changes were most apparent at 12 hours after injury, after which they gradually attenuated. Aquaporin 4 expression positively correlated with brain water content and the blood-brain barrier index. Our experimental findings indicate that increasing aquaporin 4 expression and blood-brain barrier permeability after cerebral contusion and laceration injury in humans is involved in the formation of brain edema.展开更多
Objective:To judge the efficacies of neural stem cell(NSC)transplantation on functional recovery following contusion spinal cord injuries(SCIs).Data sources:Studies in which NSCs were transplanted into a clinically re...Objective:To judge the efficacies of neural stem cell(NSC)transplantation on functional recovery following contusion spinal cord injuries(SCIs).Data sources:Studies in which NSCs were transplanted into a clinically relevant,standardized rat model of contusion SCI were identified by searching the PubMed,Embase and Cochrane databases,and the extracted data were analyzed by Stata 14.0.Data selection:Inclusion criteria were that NSCs were used in in vivo animal studies to treat contusion SCIs and that behavioral assessment of locomotor functional recovery was performed using the Basso,Beattie,and Bresnahan lo-comotor rating scale.Exclusion criteria included a follow-up of less than 4 weeks and the lack of control groups.Outcome measures:The restoration of motor function was assessed by the Basso,Beattie,and Bresnahan locomotor rating scale.Results:We identified 1756 non-duplicated papers by searching the aforementioned electronic databases,and 30 full-text articles met the inclusion criteria.A total of 37 studies reported in the 30 articles were included in the meta-analysis.The meta-analysis results showed that transplanted NSCs could improve the motor function recovery of rats following contusion SCIs,to a moderate extent(pooled standardized mean difference(SMD)=0.73;95%confidence interval(CI):0.47–1.00;P<0.001).NSCs obtained from different donor species(rat:SMD=0.74;95%CI:0.36–1.13;human:SMD=0.78;95%CI:0.31–1.25),at different donor ages(fetal:SMD=0.67;95%CI:0.43–0.92;adult:SMD=0.86;95%CI:0.50–1.22)and from different origins(brain-derived:SMD=0.59;95%CI:0.27–0.91;spinal cord-derived:SMD=0.51;95%CI:0.22–0.79)had similar efficacies on improved functional recovery;however,adult induced pluripotent stem cell-derived NSCs showed no significant efficacies.Furthermore,the use of higher doses of transplanted NSCs or the administration of immunosuppressive agents did not promote better locomotor function recovery(SMD=0.45;95%CI:0.21–0.70).However,shorter periods between the contusion induction and the NSC transplantation showed slightly higher efficacies(acute:SMD=1.22;95%CI:0.81–1.63;subacute:SMD=0.75;95%CI:0.42–1.09).For chronic injuries,NSC implantation did not significantly improve functional recovery(SMD=0.25;95%CI:–0.16 to 0.65).Conclusion:NSC transplantation alone appears to be a positive yet limited method for the treatment of contusion SCIs.展开更多
Oligodendrocyte-produced Nogo-A has been shown to inhibit axonal regeneration. Methylprednisolone plays an effective role in treating spinal cord injury, but the effect of methylprednisolone on Nogo-A in the injured s...Oligodendrocyte-produced Nogo-A has been shown to inhibit axonal regeneration. Methylprednisolone plays an effective role in treating spinal cord injury, but the effect of methylprednisolone on Nogo-A in the injured spinal cord remains unknown. The present study established a rat model of acute spinal cord injury by the weight-drop method. Results showed that after injury, the motor behavior ability of rats was reduced and necrotic injury appeared in spinal cord tissues, which was accompanied by increased Nogo-A expression in these tissues. After intravenous injection of high-dose methylprednisolone, although the pathology of spinal cord tissue remained unchanged, Nogo-A expression was reduced, but the level was still higher than normal. These findings implicate that methylprednisolone could inhibit Nogo-A expression, which could be a mechanism by which early high dose methylprednisolone infusion helps preserve spinal cord function after spinal cord injury.展开更多
AIM: To compare the reported injuries on initial assessment of the chest X-ray (CXR) in thoracic trauma patients to a second read performed by a dedicated trauma radiologist. METHODS: By retrospective analysis of a pr...AIM: To compare the reported injuries on initial assessment of the chest X-ray (CXR) in thoracic trauma patients to a second read performed by a dedicated trauma radiologist. METHODS: By retrospective analysis of a prospective database, 712 patients with an injury to the chest admitted to the University Medical Center Utrecht were studied. All patients with a CXR were included in the study. Every CXR was re-evaluated by a trauma radiologist, who was blinded for the initial results. The findings of the trauma radiologist regarding rib fractures, pneumothoraces, hemothoraces and lung contusions were compared with the initial reports from the trauma team, derived from the original patient files. RESULTS: A total of 516 patients with both thorax trauma and an initial CXR were included in the study. After re-evaluation of the initial CXR significantly more lung contusions (53.3% vs 34.1%, P < 0.001), hemothoraces (17.8% vs 11.0%, P < 0.001) and pneumothoraces (34.4% vs 26.4%, P < 0.001) were detected.During initial assessment significantly more rib fractures were reported (69.8% vs 62.3%, P < 0.001). CONCLUSION: During the initial assessment of a CXR from trauma patients in the emergency department, a significant number of treatment-dictating injuries are missed. More awareness for these specific injuries is needed.展开更多
BACKGROUND： von Willebrand factor （vWF） is only released from endothelial cells and platelets and is an in vivo and in vitro marker of endothelial injury in septic patients with acute lung injury （ALI）. Interleuk...BACKGROUND： von Willebrand factor （vWF） is only released from endothelial cells and platelets and is an in vivo and in vitro marker of endothelial injury in septic patients with acute lung injury （ALI）. Interleukin-8 （IL-8）, as a proinflammatory mediator causing recruitment of inflammatory cells, induces an increase in oxidant stress mediators and makes it as a key parameter for localized inflammation. However, it has not been well established whether the level of serum IL-8 is associated with the severity of lung injury and whether it is a prognosis marker for severe lung contusion. This study was to investigate the expression of plasma vWF and IL-8 and their association with the severity and outcomes of severe pulmonary contusion.METHODS： A total of 63 patients were divided into a severe pulmonary contusion with acute respiratory distress syndrome （ARDS） group and a non-ARDS group, or a survivor group and a non- survivor group, or an injury severity score （ISS） 〈20 group and an ISS 〉20 group. Another 20 healthy volunteers served as controls. The levels of plasma vWF and serum IL-8 were measured by enzyme- linked immunosorbent assay （ELISA） at 1,3, 5 and 7 days after injury. The expression patterns of the plasma vWF and serum IL-8 were compared between different groups. RESULTS： The concentrations of plasma vWF and serum IL-8 were significantly increased in all severe pulmonary contusion patients at all time points in comparison with the control group. The concentrations of plasma vWF in patients with ARDS increased during the whole study period, but vWF in patients with non-ARDS increased gradually until day 5 and then decreased at day 7. The concentration of serum IL-8 showed a similar expression pattern in both groups, but the expression increased more significantly in the ARDS group than in the non-ARDS group. Interestingly, both plasma vWF and serum IL-8 levels steadily increased in the non-survivor group. Furthermore, the level of plasma vWF was higher in the ISS〉20 group than in the ISS〈20 group. The level of serum IL-8 in the ISS〉20 group was consistently high, while that in the ISS〈20 group peaked at day 3 and decreased at day 5. In addition, the level of plasma vWF was positively correlated with platelet count, but negatively correlated with oxygen index. The level of serum IL-8 was positively correlated with white blood cell count and ISS score, and inversely correlated with oxygen index. CONCLUDION： The elevated levels of plasma vWF and serum IL-8 in severe pulmonary contusion patients reflect the severity of pulmonary injury and patients outcomes, suggesting that the plasma vWF and serum IL-8 are sensitive markers for clinical evaluation of the severity of pulmonary injury and predication of patient prognosis.展开更多
To evaluate the effects of glial cell line-derived neurotrophic factor transplantation combined with adipose-derived stem cells-transdifferentiated motoneuron delivery on spinal cord con-tusion injury, we developed ra...To evaluate the effects of glial cell line-derived neurotrophic factor transplantation combined with adipose-derived stem cells-transdifferentiated motoneuron delivery on spinal cord con-tusion injury, we developed rat models of spinal cord contusion injury, 7 days later, injected adipose-derived stem cells-transdifferentiated motoneurons into the epicenter, rostral and caudal regions of the impact site and simultaneously transplanted glial cell line-derived neuro-trophic factor-gelfoam complex into the myelin sheath. Motoneuron-like cell transplantation combined with glial cell line-derived neurotrophic factor delivery reduced cavity formations and increased cell density in the transplantation site. The combined therapy exhibited superior promoting effects on recovery of motor function to transplantation of glial cell line-derived neurotrophic factor, adipose-derived stem cells or motoneurons alone. These ifndings suggest that motoneuron-like cell transplantation combined with glial cell line-derived neurotrophic factor delivery holds a great promise for repair of spinal cord injury.展开更多
文摘Objective： To study the effect and indications ofintracranial pressure （ICP） monitoring for frontal lobe contusion patients. Methods： During January 2005-December 2008, 34 cases of frontal lobe contusion received ICP monitoring in our department （monitoring group）. Different treatment protocols were adopted according to the results of ICP. Mean-while 46 cases of same type of head-injured patients who did not undergo ICP monitoring served as control group. Results： We found that ICP elevated dramatically within 24 hours after head injury if the contusions were located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or dispersed in bilateral lobe. After half a year follow-up and on the basis of Glasgow Coma Scale assessment, the monitoring group showed better outcome than the control group with good recovery in 24 cases （70.6%）, moderate disability in 7 cases （20.6%）, severe disability in 2 （5.88%） and death in 1 （2.94%）. The outcome of control group displayed good condition in 25 cases （54.3%）, moderate disabilities in 8 （17.4%）, severe disability in 7 （15.2%）, and death in 6 （13.0%）. Conclusions： Frontal lobe contusions are vulnerable and complex head injuries, especially when the contusions are located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or diffused in bilateral lobes. These patients should undergo ICP monitoring regardless of their consciousness status. IflCP elevates over 25 mm Hg, the craniotomy is mandatory and will markedly reduce the mortality and disability of these patients.
基金This study was supported by Development Project of Key Laboratory of Big Data Analysis and Knowledge Service of Science and Technology Innovation Platform of Yangzhou-Yangzhou University Cooperation,Grant/Award Number:YBK202204Jiangsu Province 333 High-level Talent.Training Project,Grant/Award Number:BRA2020176。
文摘Backgroud:Thoracic Trauma and Limb Fractures Are the Two most Common Injuries in Multiple Trauma.However,there Is Still a Lack of Mouse Models of Trauma Combining Tibial Shaft Fracture(TSF)and Thoracic Trauma.In this Study,we Attempted to Develop a Novel Mouse Model of TSF Combined with Blunt Chest Trauma(BCT).Methods:A total of 84 C57BL/6J male mice were used as the multiple trauma model.BCT was induced by hitting the chests of mice with heavy objects,and TSF was in-duced by hitting the tibia of mice with heavy objects after intramedullary fixation.Serum specimens of mice were received by cardiac puncture at defined time points of 0,6,12,24,48,and 72 h.Results:Body weight and body temperature tended to decrease within 24 h after mul-tiple trauma.Hemoglobin analyses revealed a decrease during the first 24 h after mul-tiple trauma.Some animals died by cardiac puncture immediately after chest trauma.These animals exhibited the most severe pulmonary contusion and hemorrhage.The level of lung damage varied in diverse mice but was apparent in all animals.Classic he-matoxylin and eosin(H&E)-stained paraffin pulmonary sections of mice with multiple trauma displayed hemorrhage and an immunoinflammatory reaction.Bronchoalveolar lavage fluid(BALF)and serum samples of mice with multiple trauma showed an upreg-ulation of interleukin-1β(IL-1β),IL-6,and tumor necrosis factor-1α(TNF-1α)compared with the control group.Microimaging confirmed the presence of a tibia fracture and pulmonary contusion.Conclusions:The novel mouse multiple trauma model established in this study is a common trauma model that shows similar pathological mechanisms and imaging characteristics in patients with multiple injuries.This study is useful for determining whether blockade or intervention of the cytokine response is beneficial for the treat-ment of patients with multiple trauma.Further research is needed in the future.
文摘Introduction: Traumatic Brain Injury (TBI) is a major public health problem causing significant morbidity and mortality in young adults. This study aimed to describe the epidemiological, diagnostic, therapeutic, and evolutionary aspects of TBI. Materials and Methods: This was a prospective, descriptive study conducted from 1 April 2022 to 31 March 2023 on patients admitted to and treated for cranioencephalic trauma in the General Surgery department of Kara Regional Hospital. Results: Eighty-three (83) patients with cranioencephalic trauma were managed out of 773 patients admitted to the department during the study period. The mean age was 34 ± 14.98 years and the sex ratio was 3.6 in favour of men. Motorbike taxi drivers were the social group most affected (n = 33, 40%). The causes of trauma were dominated by public road accidents (n = 80;96%). TBI was mild (n = 40;48%), moderate (n = 35;42%) and severe (n = 8;10%). Cerebral CT scans were performed in 19 patients (23%). Cerebral contusion (n = 4) was the most frequent cerebral lesion. Six patients (7%) with severe head injuries were transferred to Kara University Hospital. Six deaths (7%) occurred in patients with severe head injuries. The main sequelae were intermittent headaches in all patients reviewed, and memory problems (6%). Conclusion: Traumatic brain injuries are common at Kara Regional Hospital. Severe cranial trauma is less frequent but leads to death because of financial difficulties and limited technical facilities.
基金Supported by grants from the National Natural Science Foundation of China(No.81101406)and(No.81071529)Project of Medical Research of PLA BWS12J108
文摘OBJECTIVE： To investigate the curative effects of Xuebijing （XBJ） injection, a Chinese patent medi- cine, on severe pulmonary contusion （PC）. METHODS： Sixty-three patients with PC were ran- domized to conventional therapy plus XBJ injec- tion （n=33） or conventional therapy alone （n=30）. Between groups differences in corticosteroid treat- ment, immune regulation therapy, hemofiltration, infusion volume, transfusion volume and antibiotic period were measured, as were intensive care unit（ICU）-free time, ventilation time, 28-day mortality rate and incidence of ventilation-associated pneu- monia （VAP）. Serum concentrations of procalcito- nin （PCT）, tumor necrosis factor-a （TNF-a）, interleu- kin （IL）-6, and 11_-10, white blood cell （WBC） counts and percentages of human leukocyte antigen DR/ CD14＋ （HLA-DR/CD14＋） peripheral blood mononu- clear cells were compared. Markers of ventilation were determined by blood gas analysis and ventila- tor parameters. RESULTS： WBC counts and serum concentrations of PCT, TNF-a, 11.-6 and IL-10 were reduced signifi- cantly more quickly, and CD14＋ percentage was in- creased significantly earlier, in the XBJ group than in the control group （P〈0.05 each）. The level of ven- tilation and oxygenation index were ameliorated earlier in the XBJ than in the control group （P〈 0.05）. XBJ treatment significantly reduced ICU-free time, ventilation time and incidence of VAP （P〈0.05 each）, but had no effect on 28-day mortality rate （P〉0.05）. CONCLUSION： XBJ treatment can shorten ICU-free and ventilation times and reduce the incidence of VAP, improving outcomes in patients with severe PC. XBJ may act by regulating inflammation and im- munity, alleviating systemic inflammatory response syndrome induced by trauma.
基金supported by the National Natural Science Foundation of China,No.81671902(to XC)81501704(to YC)+3 种基金the Project of Tianjin Applied Basic and Cutting-edge Technological Research of China,No.17JCYBJC25200(to XC)15JCQNJC44900(to YC)Tianjin Health Care Elite Prominent Young Doctor Development Program(to XC)the Young and Middle-aged Backbone Innovative Talent Program(to XC)
文摘Hypothalamic-pituitary-adrenal axis dysfunction may lead to the occurrence of critical illness-related corticosteroid insufficiency.Critical illness-related corticosteroid insufficiency can easily occur after traumatic brain injury,but few studies have examined this occurrence.A multicenter,prospective,cohort study was performed to evaluate the function of the hypothalamic-pituitary-adrenal axis and the incidence of critical illness-related corticosteroid insufficiency during the sub-acute phase of traumatic brain injury.One hundred and forty patients with acute traumatic brain injury were enrolled from the neurosurgical departments of three tertiary-level hospitals in China,and the critical illness-related corticosteroid insufficiency incidence,critical-illness-related corticosteroid insufficiency-related risk factors,complications,and 28-day mortality among these patients was recorded.Critical illness-related corticosteroid insufficiency was diagnosed in patients with plasma total cortisol levels less than 10μg/dL(275.9 nM)on post-injury day 4 or when serum cortisol was insufficiently suppressed(less than 50%)during a dexamethasone suppression test on post-injury day 5.The results demonstrated that critical illness-related corticosteroid insufficiency occurred during the sub-acute phase of traumatic brain injury in 5.6%of patients with mild injury,22.5%of patients with moderate injury,and 52.2%of patients with severe injury.Traumatic brain injury-induced critical illness-related corticosteroid insufficiency was strongly correlated to injury severity during the sub-acute stage of traumatic brain injury.Traumatic brain injury patients with critical illness-related corticosteroid insufficiency frequently presented with hemorrhagic cerebral contusions,diffuse axonal injury,brain herniation,and hypotension.Differences in the incidence of hospital-acquired pneumonia,gastrointestinal bleeding,and 28-day mortality were observed between patients with and without critical illness-related corticosteroid insufficiency during the sub-acute phase of traumatic brain injury.Hypotension,brain-injury severity,and the types of traumatic brain injury were independent risk factors for traumatic brain injury-induced critical illness-related corticosteroid insufficiency.These findings indicate that critical illness-related corticosteroid insufficiency is common during the sub-acute phase of traumatic brain injury and is strongly associated with poor prognosis.The dexamethasone suppression test is a practical assay for the evaluation of hypothalamic-pituitary-adrenal axis function and for the diagnosis of critical illness-related corticosteroid insufficiency in patients with traumatic brain injury,especially those with hypotension,hemorrhagic cerebral contusions,diffuse axonal injury,and brain herniation.Sub-acute infection of acute traumatic brain injury may be an important factor associated with the occurrence and development of critical illness-related corticosteroid insufficiency.This study protocol was approved by the Ethics Committee of General Hospital of Tianjin Medical University,China in December 2011(approval No.201189).
基金supported by the Lanzhou Talent Innovation and Entrepreneurship Project,No.2020-RC-40(to XXW and YBL)Cuiying Scientific Training Program for Undergraduates of Lanzhou University Second Hospital,Nos.CYXZ2020-03,CYXZ2021-01(both to YBL).
文摘Graphene and graphene-based materials have the ability to induce stem cells to differentiate into neurons,which is necessary to overcome the current problems faced in the clinical treatment of spinal cord injury.This review summarizes the advantages of graphene and graphene-based materials(in particular,composite materials)in axonal repair after spinal cord injury.These materials have good histocompatibility,and mechanical and adsorption properties that can be targeted to improve the environment of axonal regeneration.They also have good conductivity,which allows them to make full use of electrical nerve signal stimulation in spinal cord tissue to promote axonal regeneration.Furthermore,they can be used as carriers of seed cells,trophic factors,and drugs in nerve tissue engineering scaffolds to provide a basis for constructing a local microenvironment after spinal cord injury.However,to achieve clinical adoption of graphene and graphene-based materials for the repair of spinal cord injury,further research is needed to reduce their toxicity.
文摘BACKGROUND： Pattern- visual evoked potential （PVEP） can reflect the functional status of retinal ganglial cells （RGC） and visual cortex, and is an objective examination for visual pathway function. It is a unique method for objectively examining the optic nerve function of optic ganglion cells. OBJECTIVE： To observe the effects of nerve growth factor （NGF） on PVEF in the treatment of optic nerve contusion, evaluate the clinical efficacy of NGF, and make an efficacy comparison with vitamin B12. DESIGN： A randomly grouping, controlled observation. SETTING： Department of Ophthalmology, Tangshan Gongren Hospital Affiliated to Hebei Medical University. PARTICIPANTS： Forty patients with optic nerve contusion caused by eye trauma, who received the treatment in the Tangshan Worker Hospital Affiliated to Hebei Medical University between January 2006 and June 2007, were recruited in this study. The involved 40 patients, including 34 males and 6 females, were aged 14-59 years. They were confirmed to have optic nerve contusion by ophthalmologic consultation combined with history of disease and orbital CT examination. Informed consents of treatments and detected items were obtained from all the patients. The patients were randomly divided into 2 groups with 20 in each： NGF group and vitamin B12 group. METHODS： Conservative treatment was used in the two groups. In addition, patients in the NGF group were intramuscularly injected with NGF solution 18 μg /time, once a day. Those in the vitamin B12 group were injected by the same method with common vitamin B12 of 500 μg combined with vitamin B1 of 100 mg, once a day. MAIN OUTCOME MEASURES： PVEP examination was conducted in all the patients before, one and two weeks after treatment, and latency and amplitude at P100 were detected. RESULTS： Forty patients with optic nerve contusion participated in the final analysis. Before treatment, significant differences in the latency and amplitude at P100 were not found in patients between two groups （P 〉 0.05）. For each patient in the NGF group, the latency of PVEP at P100 was significantly shortened, and the amplitude was significantly increased one and two weeks after treatment as compared with vitamin B12 group（t =2.06-2.34, P 〈 0.05）. CONCLUSION： NGF treatment can obviously improve the visual function of patients with optic nerve contusion. The curative effect of NGF is superior to vitamin B12.
基金Supported by Daejeon University Research Grants (2017)。
文摘OBJECTIVE: To investigate the effects of Gyejibokryeong-Hwan(Guizhifuling-wan, GBH) on muscle injury in a mouse model of muscle contusion.METHODS: C57/BL6 mouse biceps femoris muscles were injured using the drop-mass method and injured animals were treated orally with GBH(50,100, or 500 mg/kg) once a day for 7 d. Open field and treadmill running tests were performed to assess functional recovery from muscle injury. The production of pro-inflammatory cytokines was examined by enzyme-linked immunosorbent assay and Western blotting analysis. Expression of the muscle regeneration biomarkers, myoblast determination(Myo D), myogenic factor 5(Myf5), and smooth muscle actin(α-SMA), in the biceps femoris muscle was investigated at the protein and m RNA level by Western blotting and real time-PCR, respectively. Histological analysis was performed using hematoxylin and eosin staining. Finally, myosin heavy chain production was investigated in differentiated C2C12 myoblasts in the presence of GBH.RESULTS: GBH treatment markedly improved locomotion and running behavior. GBH significantly inhibited the secretion of monocyte chemoattractant protein-1 into the bloodstream in muscle-contused animals. The levels of Myo D, Myf5, and α-SMA protein and m RNA were significantly up-regulated by GBH in injured muscle tissue. Histological studies suggested that GBH facilitated recovery from muscle damage. However, GBH did not induce the production of myosin heavy chain in vitro.CONCLUSION: Overall, the present study suggested that GBH improves the recovery of the injured muscles in the mouse model of muscle contusion.
文摘Blast-induced traumatic brain injury(b-TBI)is a kind of significant injury to soldiers in the current military conflicts.However,the mechanism of b-TBI has not been well understood,and even there are some contradictory conclusions.It is crucial to reveal the dynamic mechanism of brain volume and shear deformations under blast loading for better understanding of b-TBI.In this paper,the numerical simulation method is adopted to carry out comprehensive and in-depth researches on this issue for the first time.Based on the coupled Eulerian-Lagrangian method,the fluid-structure coupling model of the blast wave and human head is developed to simulate two situations,namely the head subjected to the frontal and lateral impacts.The simulation results are analyzed to obtain the underlying dynamic mechanisms of brain deformation.The brain volume deformation is dominated by the local bending vibration of the skull,and the corresponding frequency for the forehead skull under the frontal impact and the lateral skull faced to the lateral impact is as high as 8 kHz and 5 kHz,respectively.This leads to the high-frequency fluctuation of brain pressure and the large pressure gradient along the skull,totally different from the dynamic response of brain under head collisions.While the brain shear deformation mainly depends on the relative tangential displacement between the skull and brain and the anatomical structure of inner skull,being not related to the brain pressure and its gradient.By further comparing the medical statistics,it is inferred that diffuse axonal injury and brain contusion,the two most common types of b-TBI,are mainly attributed to brain shear deformations.And the von Mises stress can be adopted as the indicator for these two brain injuries.This study can provide theoretical guidance for the diagnosis of b-TBI and the development of protective equipment.
基金financially supported by a grant from the Natural Science Foundation of Jiangsu Province,No.BK2011180Ordinary University Graduate Student Scientific Research Innovation Projects of Jiangsu Province,No.CXZZ13-0614,CXZZ12-0609
文摘The mechanism involved in neural regeneration after spinal cord injury is unclear. The my-elin-derived protein Nogo-A, which is speciifc to the central nervous system, has been identiifed to negatively affect the cytoskeleton and growth program of axotomized neurons. Studies have shown that Nogo-A exerts immediate and chronic inhibitory effects on neurite outgrowth.In vivo, inhibitors of Nogo-A have been shown to lead to a marked enhancement of regenerative axon extension. We established a spinal cord injury model in rats using a free-falling weight drop device to subsequently investigate Nogo-A expression. Nogo-A mRNA and protein expression and immunoreactivity were detected in spinal cord tissue using real-time quantitative PCR, immu-nohistochemistry and western blot analysis. At 24 hours after spinal cord injury, Nogo-A protein and mRNA expression was low in the injured group compared with control and sham-operated groups. The levels then continued to drop further and were at their lowest at 3 days, rapidly rose to a peak after 7 days, and then gradually declined again after 14 days. These changes were observed at both the mRNA and protein level. The transient decrease observed early after injury followed by high levels for a few days indicates Nogo-A expression is time dependent. This may contribute to the lack of regeneration in the central nervous system after spinal cord injury. The dynamic varia-tion of Nogo-A should be taken into account in the treatment of spinal cord injury.
基金supported by UTS Faculty of Science Early Career Research Grant to CAG
文摘Traumatic spinal cord injury （SCI） is a detrimental condition that causes loss of sensory and motor function in an individual. Many complex secondary injury cascades occur after SCI and they offer great potential for therapeutic targeting. In this study, we investigated the response of endogenous neural progenitor cells, astrocytes, and microglia to a localized thoracic SCI throughout the neuroaxis. Twenty-five adult female Sprague-Dawley rats underwent mild-contusion thoracic SCI （n = 9）, sham surgery （n = 8）, or no surgery （n = 8）. Spinal cord and brain tissues were fixed and cut at six regions of the neuroaxis. Immunohistochem- istry showed increased reactivity of neural progenitor cell marker nestin in the central canal at all levels of the spinal cord. Increased reactivity of astrocyte-specific marker glial fibrillary acidic protein was found only at the lesion epicenter. The number of activated microglia was significantly increased at the lesion site, and activated microglia extended to the lumbar enlargement. Phagocytic microglia and macrophages were significantly increased only at the lesion site. There were no changes in nestin, glial fibrillary acidic protein, microglia and macrophage response in the third ventricle of rats subjected to mild-contusion thoracic SCI compared to the sham surgery or no surgery. These findings indicate that neural progenitor cells, astrocytes and microglia respond differently to a localized SCI, presumably due to differences in inflammatory signaling. These different cellular responses may have implications in the way that neural progenitor cells can be manipulated for neuroregeneration after SCI. This needs to be further investigated.
基金supported by NiNDS 1R01NS081040-01,1R21NS082835-01US Army W81XWH1010737+1 种基金The Miami Project to Cure ParalysisBuoniconti Fund
文摘With advances in genetic and imaging techniques, investigating axon regeneration after spinal cord injury in vivo is becoming more common in the literature. However, there are many issues to consider when using animal models of axon regeneration, including species, strains and injury models. No single particular model suits all types of experiments and each hypothesis being tested requires careful selection of the appropriate animal model. In this review, we describe several commonly-used animal models of axon regeneration in the spinal cord and discuss their advantages and disadvantages.
基金supported by the grants from South Carolina Spinal Cord Injury Research Fund(No.CIRF2017 I-01)VA award(No.RX2090)
文摘Contusion spinal cord injury(SCI)is a major medical and socio-economic problem globally.The incidence of SCI is highest among young adults due to motor vehicle accidents,military or sports injuries,and violence(Selvarajah et al.,2014).The elderly and children are also at risk due to falls and accidents.SCI causes neurodegeneration,with profound loss of locomotor and sensory functions(Siddiqui et al.,2015).Pain and depression are also prevalent in a majority of SCI patients.Expenses for severe SCI are high:initial hospitalization,rehabilitation,and most likely the continuing need for a caregiver and medical care.SCI survivors with less severe injuries usually face lower but still hefty medical bills.However,people≥50 years old with severe SCI may face medical expenses of over$1.8 million during their lifetimes.These injuries also affect spouses and family members,emotionally and financially,and most injuries jeopardize employment for those affected.
文摘Spinal cord injury is a major cause of disability with devastating neurological outcomes and lim-ited therapeutic opportunities, even though there are thousands of publications on spinal cord injury annually. There are two major types of spinal cord injury, transaction of the spinal cord and spinal cord contusion. Both can theoretically be treated, but there is no well documented treatment in human being. As for spinal cord contusion, we have developed an operation with fabulous result.
文摘This study aimed to investigate aquaporin 4 expression and the ultrastructure of the blood-brain barrier at 2-72 hours following cerebral contusion injury, and correlate these changes to the formation of brain edema. Results revealed that at 2 hours after cerebral contusion and laceration injury, aquaporin 4 expression significantly increased, brain water content and blood-brain barrier permeability increased, and the number of pinocytotic vesicles in cerebral microvascular endothelia cells increased. In addition, the mitochondrial accumulation was observed. As contusion and laceration injury became aggravated, aquaporin 4 expression continued to increase, brain water content and blood-brain barrier permeability gradually increased, brain capillary endothelial cells and astrocytes swelled, and capillary basement membrane injury gradually increased. The above changes were most apparent at 12 hours after injury, after which they gradually attenuated. Aquaporin 4 expression positively correlated with brain water content and the blood-brain barrier index. Our experimental findings indicate that increasing aquaporin 4 expression and blood-brain barrier permeability after cerebral contusion and laceration injury in humans is involved in the formation of brain edema.
基金supported by the National Natural Science Foundation of China,No.81171147“Key Medical Talents of Qiangwei Project” Research Foundation of Health Department of Jiangsu Province of China,No.ZDRCA2016010+1 种基金“Xingwei Project” Key Personal Medical Research Foundation of Health Department of Jiangsu Province of China,No.RC201156Jiangsu Provincial Key Discipline of Medicine of China,No.XK201117(all to LXL)
文摘Objective:To judge the efficacies of neural stem cell(NSC)transplantation on functional recovery following contusion spinal cord injuries(SCIs).Data sources:Studies in which NSCs were transplanted into a clinically relevant,standardized rat model of contusion SCI were identified by searching the PubMed,Embase and Cochrane databases,and the extracted data were analyzed by Stata 14.0.Data selection:Inclusion criteria were that NSCs were used in in vivo animal studies to treat contusion SCIs and that behavioral assessment of locomotor functional recovery was performed using the Basso,Beattie,and Bresnahan lo-comotor rating scale.Exclusion criteria included a follow-up of less than 4 weeks and the lack of control groups.Outcome measures:The restoration of motor function was assessed by the Basso,Beattie,and Bresnahan locomotor rating scale.Results:We identified 1756 non-duplicated papers by searching the aforementioned electronic databases,and 30 full-text articles met the inclusion criteria.A total of 37 studies reported in the 30 articles were included in the meta-analysis.The meta-analysis results showed that transplanted NSCs could improve the motor function recovery of rats following contusion SCIs,to a moderate extent(pooled standardized mean difference(SMD)=0.73;95%confidence interval(CI):0.47–1.00;P<0.001).NSCs obtained from different donor species(rat:SMD=0.74;95%CI:0.36–1.13;human:SMD=0.78;95%CI:0.31–1.25),at different donor ages(fetal:SMD=0.67;95%CI:0.43–0.92;adult:SMD=0.86;95%CI:0.50–1.22)and from different origins(brain-derived:SMD=0.59;95%CI:0.27–0.91;spinal cord-derived:SMD=0.51;95%CI:0.22–0.79)had similar efficacies on improved functional recovery;however,adult induced pluripotent stem cell-derived NSCs showed no significant efficacies.Furthermore,the use of higher doses of transplanted NSCs or the administration of immunosuppressive agents did not promote better locomotor function recovery(SMD=0.45;95%CI:0.21–0.70).However,shorter periods between the contusion induction and the NSC transplantation showed slightly higher efficacies(acute:SMD=1.22;95%CI:0.81–1.63;subacute:SMD=0.75;95%CI:0.42–1.09).For chronic injuries,NSC implantation did not significantly improve functional recovery(SMD=0.25;95%CI:–0.16 to 0.65).Conclusion:NSC transplantation alone appears to be a positive yet limited method for the treatment of contusion SCIs.
文摘Oligodendrocyte-produced Nogo-A has been shown to inhibit axonal regeneration. Methylprednisolone plays an effective role in treating spinal cord injury, but the effect of methylprednisolone on Nogo-A in the injured spinal cord remains unknown. The present study established a rat model of acute spinal cord injury by the weight-drop method. Results showed that after injury, the motor behavior ability of rats was reduced and necrotic injury appeared in spinal cord tissues, which was accompanied by increased Nogo-A expression in these tissues. After intravenous injection of high-dose methylprednisolone, although the pathology of spinal cord tissue remained unchanged, Nogo-A expression was reduced, but the level was still higher than normal. These findings implicate that methylprednisolone could inhibit Nogo-A expression, which could be a mechanism by which early high dose methylprednisolone infusion helps preserve spinal cord function after spinal cord injury.
文摘AIM: To compare the reported injuries on initial assessment of the chest X-ray (CXR) in thoracic trauma patients to a second read performed by a dedicated trauma radiologist. METHODS: By retrospective analysis of a prospective database, 712 patients with an injury to the chest admitted to the University Medical Center Utrecht were studied. All patients with a CXR were included in the study. Every CXR was re-evaluated by a trauma radiologist, who was blinded for the initial results. The findings of the trauma radiologist regarding rib fractures, pneumothoraces, hemothoraces and lung contusions were compared with the initial reports from the trauma team, derived from the original patient files. RESULTS: A total of 516 patients with both thorax trauma and an initial CXR were included in the study. After re-evaluation of the initial CXR significantly more lung contusions (53.3% vs 34.1%, P < 0.001), hemothoraces (17.8% vs 11.0%, P < 0.001) and pneumothoraces (34.4% vs 26.4%, P < 0.001) were detected.During initial assessment significantly more rib fractures were reported (69.8% vs 62.3%, P < 0.001). CONCLUSION: During the initial assessment of a CXR from trauma patients in the emergency department, a significant number of treatment-dictating injuries are missed. More awareness for these specific injuries is needed.
文摘BACKGROUND： von Willebrand factor （vWF） is only released from endothelial cells and platelets and is an in vivo and in vitro marker of endothelial injury in septic patients with acute lung injury （ALI）. Interleukin-8 （IL-8）, as a proinflammatory mediator causing recruitment of inflammatory cells, induces an increase in oxidant stress mediators and makes it as a key parameter for localized inflammation. However, it has not been well established whether the level of serum IL-8 is associated with the severity of lung injury and whether it is a prognosis marker for severe lung contusion. This study was to investigate the expression of plasma vWF and IL-8 and their association with the severity and outcomes of severe pulmonary contusion.METHODS： A total of 63 patients were divided into a severe pulmonary contusion with acute respiratory distress syndrome （ARDS） group and a non-ARDS group, or a survivor group and a non- survivor group, or an injury severity score （ISS） 〈20 group and an ISS 〉20 group. Another 20 healthy volunteers served as controls. The levels of plasma vWF and serum IL-8 were measured by enzyme- linked immunosorbent assay （ELISA） at 1,3, 5 and 7 days after injury. The expression patterns of the plasma vWF and serum IL-8 were compared between different groups. RESULTS： The concentrations of plasma vWF and serum IL-8 were significantly increased in all severe pulmonary contusion patients at all time points in comparison with the control group. The concentrations of plasma vWF in patients with ARDS increased during the whole study period, but vWF in patients with non-ARDS increased gradually until day 5 and then decreased at day 7. The concentration of serum IL-8 showed a similar expression pattern in both groups, but the expression increased more significantly in the ARDS group than in the non-ARDS group. Interestingly, both plasma vWF and serum IL-8 levels steadily increased in the non-survivor group. Furthermore, the level of plasma vWF was higher in the ISS〉20 group than in the ISS〈20 group. The level of serum IL-8 in the ISS〉20 group was consistently high, while that in the ISS〈20 group peaked at day 3 and decreased at day 5. In addition, the level of plasma vWF was positively correlated with platelet count, but negatively correlated with oxygen index. The level of serum IL-8 was positively correlated with white blood cell count and ISS score, and inversely correlated with oxygen index. CONCLUDION： The elevated levels of plasma vWF and serum IL-8 in severe pulmonary contusion patients reflect the severity of pulmonary injury and patients outcomes, suggesting that the plasma vWF and serum IL-8 are sensitive markers for clinical evaluation of the severity of pulmonary injury and predication of patient prognosis.
基金funded by Shefa Neurosciences Research Center at Khatam Al-Anbia Hospital,Tehran,Iran(Grant#86-N-105)
文摘To evaluate the effects of glial cell line-derived neurotrophic factor transplantation combined with adipose-derived stem cells-transdifferentiated motoneuron delivery on spinal cord con-tusion injury, we developed rat models of spinal cord contusion injury, 7 days later, injected adipose-derived stem cells-transdifferentiated motoneurons into the epicenter, rostral and caudal regions of the impact site and simultaneously transplanted glial cell line-derived neuro-trophic factor-gelfoam complex into the myelin sheath. Motoneuron-like cell transplantation combined with glial cell line-derived neurotrophic factor delivery reduced cavity formations and increased cell density in the transplantation site. The combined therapy exhibited superior promoting effects on recovery of motor function to transplantation of glial cell line-derived neurotrophic factor, adipose-derived stem cells or motoneurons alone. These ifndings suggest that motoneuron-like cell transplantation combined with glial cell line-derived neurotrophic factor delivery holds a great promise for repair of spinal cord injury.
