Open pelvic fractures associated with anorectal injuries:emergency management strategies and risk factors for mortality

Objective To investigate emergency management strategies and risk factors for mortality of open pelvic fractures associated with anorectal injuries.Methods Between April 2001 to April 2010,25 patients of openpelvic fractures

Liver injury associated with Malva grandifolia

To the Editor: Dietary supplements and herbal products are an increasingly common source of drug-induced liver injury. An increasing number of case reports have suggested causative supplement-associated liver toxicity. [1] Malva grandifolia is a plant which is frequently found in flower and vegetable gardens (Fig.). Mallow products are used

Human umbilical cord blood stem cell transplantation for the treatment of chronic spinal cord injury Electrophysiological changes and long-term efficacy

Stem cell transplantation can promote functional restoration following acute spinal cord injury （injury time 〈 3 months）, but the safety and long-term efficacy of this treatment need further exploration. In this study, 25 patients with traumatic spinal cord injury （injury time 〉 6 months） were treated with human umbilical cord blood stem cells via intravenous and intrathecal injection. The follow-up period was 12 months after transplantation. Results found that autonomic nerve functions were restored and the latent period of somatosensory evoked potentials was reduced. There were no severe adverse reactions in patients following stem cell transplantation. These experimental findings suggest that the transplantation of human umbilical cord blood stem cells is a safe and effective treatment for patients with traumatic spinal cord injury

Factors related to improved American Spinal Injury Association grade of acute traumatic spinal cord injury

BACKGROUND Acute traumatic spinal cord injury(ATSCI)usually results in disability,yet data on contemporary national trends of ATSCI incidence are limited.AIM To provide a systematic and basic theoretical basis for improving the treatment of acute spinal cord injury.METHODS Data from the Peking University Third Hospital Inpatient Sample databases were analyzed.A total of 304 patients with ATSCI were included from 2012 to 2017.The epidemiological data,treatment,complications and clinical outcomes of these patients were reviewed.RESULTS Of the 304 patients,257(84.5%)were male,and 75%of the patients were 55 years old or younger.135 patients had improved follow-up American Spinal Injury Association(ASIA)grades(44.4%).Only 14 patients with ASIA grade A improved.A statistically significant difference in prognosis between patients who underwent surgery within 72 h and those who underwent surgery after 72 h was observed(P<0.05).Surgery within 72 h resulted in better prognosis.The Steroid group and the Non-Steroid group showed a significant difference in outcome among patients with ASIA grades A and B(P<0.05).Patients with pneumonia had a poorer prognosis than patients without pneumonia(P<0.05).Surgery within 72 h resulted in better prognosis.CONCLUSION This study found that there was no significant difference in hospitalization time and prognosis between the Steroid group and the Non-Steroid group,but the patients with severe spinal cord injury(ASIA grades A and B)who underwent surgery combined with steroid therapy had a better prognosis than those who underwent surgery alone.The disastrous consequences of ATSCI and lack of consensus on the management strategy are obvious.Further improvements in treatment planns are needed in order to obtain more reliable functional outcomes.

Surgical intervention combined with weight-bearing walking training improves neurological recoveries in 320 patients with clinically complete spinal cord injury:a prospective self-controlled study

Although a large number of trials in the SCI field have been conducted,few proven gains have been realized for patients.In the present study,we determined the efficacy of a novel combination treatment involving surgical intervention and long-term weight-bearing walking training in spinal cord injury(SCI)subjects clinically diagnosed as complete or American Spinal Injury Association Impairment Scale(AIS)Class A(AIS-A).A total of 320 clinically complete SCI subjects(271 male and 49 female),aged 16–60 years,received early(≤7 days,n=201)or delayed(8–30 days,n=119)surgical interventions to reduce intraspinal or intramedullary pressure.Fifteen days post-surgery,all subjects received a weight-bearing walking training with the“Kunming Locomotion Training Program(KLTP)”for a duration of 6 months.The neurological deficit and recovery were assessed using the AIS scale and a 10-point Kunming Locomotor Scale(KLS).We found that surgical intervention significantly improved AIS scores measured at 15 days post-surgery as compared to the pre-surgery baseline scores.Significant improvement of AIS scores was detected at 3 and 6 months and the KLS further showed significant improvements between all pair-wise comparisons of time points of 15 days,3 or 6 months indicating continued improvement in walking scores during the 6-month period.In conclusion,combining surgical intervention within 1 month post-injury and weight-bearing locomotor training promoted continued and statistically significant neurological recoveries in subjects with clinically complete SCI,which generally shows little clinical recovery within the first year after injury and most are permanently disabled.This study was approved by the Science and Research Committee of Kunming General Hospital of PLA and Kunming Tongren Hospital,China and registered at ClinicalTrials.gov(Identifier:NCT04034108)on July 26,2019.

Fine motor skill training enhances functional plasticity of the corticospinal tract after spinal cord injury

Following central nervous system injury, axonal sprouts form distal to the injury site and extend into the denervated area, reconstructing neural circuits through neural plasticity. How to facilitate this plasticity has become the key to the success of central nervous system repair. It remains controversial whether fine motor skill training contributes to the recovery of neurological function after spinal cord injury. Therefore, we established a rat model of unilateral corticospinal tract injury using a pyramidal tract cutting method. Horizontal ladder crawling and food ball grasping training procedures were conducted 2 weeks before injury and 3 days after injury. The neurological function of rat forelimbs was assessed at 1, 2, 3, 4, and 6 weeks after injury. Axon growth was observed with biotinylated dextran amine anterograde tracing in the healthy corticospinal tract of the denervated area at different time periods. Our results demonstrate that compared with untrained rats, functional recovery was better in the forelimbs and forepaws of trained rats. The number of axons and the expression of growth associated protein 43 were increased at the injury site 3 weeks after corticospinal tract injury. These findings confirm that fine motor skill training promotes central nervous system plasticity in spinal cord injury rats.

Treatment strategy on traumatic mid-lumbar spondyloptosis with concomitant multiple injuries:A case report and literature review

Spondyloptosis in the clinic is rarely reported.We herein present a 47-year-old female,who suffered from a crush injury directly by a heavy cylindrical object from the lateral side.She was diagnosed to have traumatic L3 spondyloptosis with multiple traumas.Staged surgical procedures were conducted and a three-year follow-up was obtained.Eventually,normal spinal alignment was restored,and neurological deficits were gradually improved.At three years follow-up,the motor strength scores and function of the sphincters were incompletely improved.Previously published reports on traumatic lumbar spondyloptosis were reviewed and several critical points for management of this severe type of spinal injury were proposed.First,thoracolumbar and lumbosacral junction were mostly predilection sites.Second,numerous patients involving traumatic lumbar spondyloptosis were achieved to American Spinal Injury Association grade A.Third,lumbar spondyloptosis was commonly coupling withcauda equina injury.Finally,the outcomes were still with poorly prognosis and recovery of patients was correlation to spondyloptosis severity.Based on this case report and literatures review,we highlighted that the spinal alignment restoration relying on staged operations and following rehabilitation hereof are both important once facing with multiple traumas.Furthermore,we suggested to perform routine CT angiography during lumbar spondyloptosis to justify whether there are large vessel compression or injury.

Nutech functional score: A novel scoring system to assess spinal cord injury patients

AIM To develop a new scoring system, nutech functional scores(NFS) for assessing the patients with spinal cord injury(SCI).METHODS The conventional scale, American Spinal Injury Association's(ASIA) impairment scale is a measure which precisely describes the severity of the SCI.However, it has various limitations which lead to incomplete assessment of SCI patients.We have developed a 63 point scoring system, i.e., NFS for patients suffering with SCI.A list of symptoms either common or rare that were found to be associated with SCI was recorded for each patient.On the basis of these lists, we have developed NFS.RESULTS These lists served as a base to prepare NFS, a 63 point positional(each symptom is sub-graded and get points based on position) and directional(moves in direction BAD → GOOD) scoring system.For non-progressive diseases, 1, 2, 3, 4, 5 denote worst, bad, moderate, good and best(normal), respectively.NFS for SCI has been divided into different groups based on the affected part of the body being assessed, i.e., motor assessment(shoulders, elbow, wrist, fingers-grasp, fingers-release, hip, knee, ankle and toe), sensory assessment, autonomic assessment, bed sore assessment and general assessment.As probability based studies required a range of(-1, 1) or at least the range of(0, 1) to be useful for real world analysis, the grades were converted to respective numeric values.CONCLUSION NFS can be considered as a unique tool to assess the improvement in patients with SCI as it overcomes the limitations of ASIA impairment scale.

Changes in and effective factors of microtubule associated protein 2 in traumatic neurons

Objective To investigate alterations in the microtubule-associated protein 2 (MAP-2) of neurons in Wistar rats and the effect of nimodipine (Nim), D-2-amino-5-phosphonovaleric acid (D-AP-5) and mild hypothermia on neuronal MAP-2 following fluid percussion injury (FPI).Methods Alterations of MAP-2 in Wistar rat neurons following FPI were measured by a confocal laserscanning microscope using MAP-2 immunofluorescence staining as a MAP-2 indicator.Results MAP-2 immunofluorescence staining was limited to the cell bodies and dendritic compartments of neurons and more intense in dendrites than in cell bodies. The loss of MAP-2 was marked at 3 h posttrauma ( P ＜ 0.01 ), and reached a maximum at 48 h post-trauma. Afterwards, fluorescence recovered partly at 72 h post-trauma. The application of Nim markedly reduced the loss of MAP-2 immunoreectivity within 1 h post-trauma ( P ＜ 0.01 ), and the application of D-AP-5 markedly reduced the loss of MAP-2immunoreactivity within 10 h post-injury ( P ＜ 0.01 ). The application of mild hypothermia decreased the loss of MAP-2 immunoreactivity within 1 h post-injury (P＜ 0.05).Conclusions The partial recovery of fluorescence at 72 h post-trauma indicate that the partial structure of the neuronal microtubules can be repaired by itself. Nim, D-AP-5 and mild hypothermia reduce the degradation of MAP-2 by different mechanisms. The treatment of neuronal cytoskeleton degradation following FPI must employ multiple therapeutic approaches.

Economic impact of traumatic spinal cord injuries in the United States

Individuals having sustained traumatic spinal cord injury(TSCI)in the United States are living longer as compared to historical trends,thanks to an ever-evolving understanding of the nature of this injury.Despite this,multiple barriers to care for TSCI patients remain including variations in government-issued veteran insurance,privatized insurance,and among uninsured individuals.The United States alone experiences 12,000 new TSCI cases every year,many of these are found to occur in a growing proportion of elderly individuals.It is crucial to understand both the short-term direct costs as wells as the long-term rehabilitation costs required by these TSCI patients.The lifetime financial burden for those having sustained a TSCI can be immense for patients,insurance companies,and hospital systems alike.Among those with TSCI,re-hospitalization rates are high,leading to increased healthcare resource utilization within this specific patient population.Costs can quickly balloon into hundreds of thousands of dollars and cause a profound financial burden for these patients.This review article seeks to communicate an understanding of the current financial landscape surrounding TSCI patients.The authors will also examine the costs of acute emergency room surgical care such as American spinal injury association grade,hospital length of stay,as well as the timing delay between injury and surgical decompression.Long-term costs associated with TSCI such as rehabilitation,care of secondary comorbidities,and post-injury employment prospects will be examined as well.These costs will be framed from the patient's perspective as well as from both the hospital and insurance company's perspectives.It is hoped a complete understanding as to what makes TSCI such a medically and financially burdensome injury will allow for improved healthcare resource utilization in this population.

Neuroprotective effect of recombinant human erythropoietin on optic nerve injury in rats

Background Optic nerve injury, caused by retinal and optic nerve diseases, can eventually result in vision loss. To date, few effective treatments have been discovered to restore visual function. Previous studies showed that recombinant human erythropoietin （rhEPO） has a neuroprotective effect on the central nervous system, particularly in nerve injury. In this study, we investigated the effects of rhEPO on axonal regeneration and functional restoration following optic nerve injury. This was done by measuring the expression of growth associated protein 43 （GAP-43）, a marker for neuronal regeneration, on the retina and flash-visual evoked potential （F-VEP）. Methods Adult Wistar rats were randomly assigned to rhEPO and control （saline） groups. Optic nerve crush injury models were established and rhEPO or saline were immediately injected into the vitreous cavity. The expression of GAP-43 was detected by immunohistochemistry and the F-VEP was measured pre-injury, immediately after injury, 1 week and 2 weeks post-injury. Results No detectable staining for GAP-43 was observed in normal retina. In the control group, the level of GAP-43 expression was higher at 1 week post-injury, but decreased at 2 weeks. In the rhEPO group, the level of GAP-43 expression was notably higher at both 1 week and 2 weeks. At each time point post-injury, the expression of GAP-43 in rhEPO group was significantly higher than the control group （P 〈0.05）. Obvious changes in F-VEP examination were detected immediately after optic nerve injury, including significantly prolonged latency and decreased amplitude of the P1 wave. In the control group, the changes were still obvious at 1 week. The latency was decreased and the amplitude had slightly recovered to 28.23% of the normal value at 2 weeks. In rhEPO group, there was significantly more recovery than the control group at 1 week and 2 weeks post-injury （P 〈0.05）. The latency most close to the normal level and the amplitude had recovered to 65.51% of the normal value at 2 weeks. Conclusions rhEPO can prolong the expression of GAP-43 and increase its intensity after optic nerve injury, thereby promoting neural repair and axonal regeneration. Under the protection of rhEPO, the conduction velocity of the optic nerve recovered significantly. Therefore, rhEPO has neuroprotective effects on the optic nerve and promotes functional restoration of the optic nerve. Chin Med J 2009;122（17）：2008-2012