Management of Traumatic Brain Injuries at the Kara Regional Hospital

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.

Implications of periostin in the development of subarachnoid hemorrhage-induced brain injuries

Target of research in subarachnoid hemorrhage（SAH）：The outcome of aneurysmal SAH remains poor despite advances in the diagnosis and treatment.Although many factors related to patients,aneurysms,and institutions,as well as physiological parameters and medical complications were reported as prognostic factors,

Neuroprotectants attenuate hypobaric hypoxia-induced brain injuries in cynomolgus monkeys

Hypobaric hypoxia (HH) exposure can cause serious brain injury as well as life-threatening cerebral edema in severe cases. Previous studies on the mechanisms of HH-induced brain injury have been conducted primarily using non-primate animal models that are genetically distant to humans, thus hindering the development of disease treatment. Here, we report that cynomolgus monkeys (Macaca fascicularis) exposed to acute HH developed human-like HH syndrome involving severe brain injury and abnormal behavior. Transcriptome profiling of white blood cells and brain tissue from monkeys exposed to increasing altitude revealed the central role of the HIF-1 and other novel signaling pathways, such as the vitamin D receptor (VDR) signaling pathway, in co-regulating HH-induced inflammation processes. We also observed profound transcriptomic alterations in brains after exposure to acute HH, including the activation of angiogenesis and impairment of aerobic respiration and protein folding processes, which likely underlie the pathological effects of HH-induced brain injury. Administration of progesterone (PROG) and steroid neuroprotectant 5α-androst-3β,5,6β-triol (TRIOL) significantly attenuated brain injuries and rescued the transcriptomic changes induced by acute HH. Functional investigation of the affected genes suggested that these two neuroprotectants protect the brain by targeting different pathways, with PROG enhancing erythropoiesis and TRIOL suppressing glutamate-induced excitotoxicity. Thus, this study advances our understanding of the pathology induced by acute HH and provides potential compounds for the development of neuroprotectant drugs for therapeutic treatment.

Toll-like receptor 4 as a possible therapeutic target for delayed brain injuries after aneurysmal subarachnoid hemorrhage

Neuroinflammation is a well-recognized consequence of subarachnoid hemorrhage（SAH）, and Toll-like receptor（TLR） 4 may be an important therapeutic target for post-SAH neuroinflammation. Of the TLR family members, TLR4 is expressed in various cell types in the central nervous system, and is unique in that it can signal through both the myeloid differentiation primary-response protein 88-dependent and the toll receptor associated activator of interferon-dependent cascades to coordinate the maximal inflammatory response. TLR4 can be activated by many endogenous ligands having damage-associated molecular patterns including heme and fibrinogen at the rupture of an intracranial aneurysm, and the resultant inflammatory reaction and thereby tissue damages may furthermore activate TLR4. It is widely accepted that the excreted products of TLR4 signaling alter neuronal functions. Previous studies have focused on the pathway through nuclear factor（NF）-κΒ signaling among TLR4 signaling pathways as to the development of early brain injury（EBI） such as neuronal apoptosis and blood-brain barrier disruption, and cerebral vasospasm. However, many findings suggest that both pathways via NF-κΒ and mitogen-activated protein kinases may be involved in EBI and cerebral vasospasm development. To overcome EBI and cerebral vasospasm is important to improve outcomes after SAH, because both EBI and vasopasm are responsible for delayed brain injuries or delayed cerebral ischemia, the most important preventable cause of poor outcomes after SAH. Increasing evidence has shown that TLR4 signaling plays an important role in SAH-induced brain injuries. Better understanding of the roles of TLR4 signaling in SAH will facilitate development of new treatments.

Epidemiological and clinical features of paediatric open globe injuries in southwestern Turkey

AIM:To evaluate the epidemiologic,anatomic,and clinical features of open globe injuries in children.METHODS:The medical files of patients under the age of 16 who had been operated for an open globe injury at Akdeniz University Hospital’s Department of Ophthalmology were retrospectively evaluated.RESULTS:A total of 90 patients were evaluated in this study.Among these patients,26(28.9%)were female and64(71.1%)were male.The mean age of the patients was7.7±4.2 years.The male/female ratio was observed to increase with increasing age(P=0.006,P=7.48).Injuries were most likely to occur in spring and autumn(P=0.028).The time interval between the injury and the surgical repair was 9.36±27.4h.Forty(44.4%)of the injuries occurred in the home,27(30%)occurred in the yard,and 21(23.3%)happened while playing in the street.The most common causes of injury were sharp metal objects(P【0.001).Injury to the cornea occurred in47(52.2%)of the patients(P【0.001).The most common complication to occur was cataract formation.Additional operations were necessary for 37(41.1%)of the patients.The final visual acuity was correlated with both the initial visual acuity of the wounded eye prior to surgery and the length of the wound(P【0.001,r=0.502 and P【0.001,r=-0.442,respectively).CONCLUSION:Open globe injuries that are suffered in childhood generally occur either at home,in the yard,or on the street,with sharp metal objects being the most common cause of injury.The initial visual acuity and the length of the wound are the most important determinants of the final visual acuity.

Homer signaling pathways as effective therapeutic targets for ischemic and traumatic brain injuries and retinal lesions

Ischemic and traumatic insults to the central nervous system account for most serious acute and fatal brain injuries and are usually characterized by primary and secondary damage.Secondary damage presents the greatest challenge for medical staff;however,there are currently few effective therapeutic targets for secondary damage.Homer proteins are postsynaptic scaffolding proteins that have been implicated in ischemic and traumatic insults to the central nervous system.Homer signaling can exert either positive or negative effects during such insults,depending on the specific subtype of Homer protein.Homer 1b/c couples with other proteins to form postsynaptic densities,which form the basis of synaptic transmission,while Homer 1a expression can be induced by harmful external factors.Homer 1c is used as a unique biomarker to reveal alterations in synaptic connectivity before and during the early stages of apoptosis in retinal ganglion cells,mediated or affected by extracellular or intracellular signaling or cytoskeletal processes.This review summarizes the structural features,related signaling pathways,and diverse roles of Homer proteins in physiological and pathological processes.Upregulating Homer 1a or downregulating Homer 1b/c may play a neuroprotective role in secondary brain injuries.Homer also plays an important role in the formation of photoreceptor synapses.These findings confirm the neuroprotective effects of Homer,and support the future design of therapeutic drug targets or gene therapies for ischemic and traumatic brain injuries and retinal disorders based on Homer proteins.

Application of pediatric ocular trauma score in pediatric open globe injuries

AIM:To evaluate the predictive value of pediatric penetrating ocular trauma score(POTS)on the visual outcome in children with open globe injury.METHODS:A retrospective study in 90 children(60 males and 30 females)aged 1-15 y(average,7.48±2.86 y)with penetrating ocular trauma was performed.Each patient’s POTS was calculated.The effects of POTS on final visual acuity(FVA)were examined.Correlation between factors affecting POTS and the FVA was established.RESULTS:All patients presented with single-eye trauma.The follow-up time was 3-21 mo(average,10.23±3.54 mo).Among the 90 cases of penetrating wounds,71 eyes(78.89%)were injured in Zone I(wound involvement limited to the cornea,including the corneoscleral limbus),17 eyes(18.89%)were injured in Zone II(wound involving the sclera and no more posterior than 5 mm from the corneoscleral limbus),and 2 eyes(2.22%)were injured in Zone III(wound involvement posterior to the anterior 5 mm of the sclera).Analysis of POTS and FVA showed important correlation between them(r=0.414,P=0.000).Initial visual acuity(P=0.00),age(P=0.02),injury location(P=0.002),traumatic cataract(P=0.00),vitreous hemorrhage(P=0.027),retinal detachment(P=0.003),and endophthalmitis(P=0.03)were found to be statistically significant factors for the FVA outcome.CONCLUSION:Ocular trauma presents serious consequences and poor prognosis in children.The POTS may be a reliable prognostic tool in children with open globe injury.

Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system

AIMTo determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS.METHODSA prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome.RESULTSThere were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outcomes in this category were not found to be different from OTS outcomes. Outcomes were significantly worse in Category 2, but when the entire distribution was tested, the differences were not statistically significant. The overall association between OTS outcomes and the final visual outcomes in this study was found to be a strong (P<0.005).CONCLUSIONReliable information regarding the expected outcomes of eye injuries will influence management decisions and patient expectations. The OTS is a valuable tool, the use of which has been validated in many parts of the world-it may also be a valid predictor in an African setting.

Huayu capsule enhances limb-catching capability of rats with experimental open traumatic brain injury

BACKGROUND： It is hard to cure the open traumatic brain injury （TBI）, especially for the brain functional recovery after brain injury. In this regard, traditional Chinese medicine （TCM） has a wide prospect. OBJECTIVE： To observe the effect of Huayu capsule on limb-catching capability of rat models of open TBI, and investigate its possible mechanism. DESIGN： Randomized and controlled study. SETTING： Grade 3 Pharmacological Laboratory of TCM, State Administration of TCM, Chengdu University of TCM. MATERIALS： This study was performed from October 2005 to January 2006. Fifty Sprague-Dawley rats of either gender, aged 3 months old, weighing from 190 to 220 g, were involved in this study. Huayu capsule was made and supplied by the Department of TCM Processing of Chengdu University of TCM, Lot No. 050121; Xuefuzhuyu oral liquid was manufactured by Jilin Aodong Yanbian Pharmaceutical Industry Co.,Ltd., Lot No. 050406. METHODS： Open right parietal lobe TBI rat models were made as described in references. The involved rat models were randomized into 5 groups according to gender and body mass： model group, high-, middle-, low-dose Huayu capsule groups and Xuefuzhuyu oral liquid group, with 10 rats in each. Rats in the model group were administrated with distilled water of 5 mL/kg; Rats in the high-, middle- and low-dose Huayu capsule groups were administrated with 1.030, 0.515, 0.258 g/kg raw herbs; Rats in the Xuefuzhuyu oral liquid group were administrated with Xuefuzhuyu oral liquid of 5 mL/kg, intragastrically once a day for 7 days successively for all after recovering consciousness from anesthetization. ① One hour after administration on the 6^th day, rats in each group were placed on a 100 cm fine straight iron wire paralleling to the ground and 20 cm above the operational table. The time of the rats keeping on the wire was counted and it indicated the nerve-muscle catching capability. The longer the remained time, the better the nerve-muscle catching capability.② Twenty-four hours after the administration on the 7^th day, the samples of the whole brain were carefully taken out and stained by toluidine blue for observing the morphology of cells in the injured brain tissue. ③ The nerve cells in 4 visual fields from 4 directions （upper, lower, left, right） of injured area of brain tissue were counted. The amount was the total number of the four visual fields. The nerve cells in the injured brain tissue were measured by the same way. ④ On the basis of nerve cell counting, the content of Nissl＇s body in the corresponding nerve cells was measured. MAIN OUTCOME MEASURES： ①Nerve-muscle catching capability. ②Histopathomorphological examination of the injured areas in brain. ③Measurement of nerve cells and macrophages in the injured areas of brain. ④Measurement of content of Nissl＇s body in the injured areas of brain. RESULTS： All the 50 rats were involved in the final analysis. ①The catching time of rats in the high- and middle-dose Huayu capsule groups as well as Xuefuzhuyu oral liquid group was extended to （ 23.6 ± 10.12 ）, （ 18.6 ± 8.17 ） and （22.6 ± 9.43） s, respectively, which was significantly higher than that in the model group [ （12.1 ± 4.15） s, P 〈 0.05 - 0.01 ]. ② The injured areas of brain tissue of rats in the Huayu capsule-treated groups and Xuefuzhuyu oral liquid group were decreased to different extents. The nerve cells adjacent to brain injured area were increased. ③ The number of macrophages around the brain injured area of rats in the high- and middle-dose Huayu capsule groups as well as Xuefuzhuyu oral liquid group was 63.9 ± 7.99, 59.7 ± 7.41 and 62.9 ± 7.37, respectively, which was significantly larger than that in the model group （49.2 ± 8.00, P 〈 0.01 ） . The number of nerve cells adjacent to brain injured area of rats in the high-, middle-, and low-dose Huayu capsule groups as well as Xuefuzhuyu oral liquid group was 86.2 ± 25.93, 93.5 ± 31.79, 92.1 ± 14.54 and 125.2 ±34.25, respectively, which was significantly larger than that in the model group （62.5 ± 16.98, P 〈 0.05 -0.01 ） .④ The total area, the total and integral absorbance, the average gray degree of Nissl＇s body in the cytoplasm of nerve cells of rats in the Huayu capsule-treated groups and Xuefuzhuyu oral liquid group were all significantly increased （P 〈 0.05 - 0.01）. CONCLUSION： Huayu capsule at different doses can promote the limb-catching capability of rat models of open TBI to different extent. This promoting effect may be related to increasing macrophages in the injured area, lessening the apoptosis of nerve cells and increasing the content of Nissl＇s body in the nerve cells.

Favorable Outcome in Open Globe Injuries with Low OTS Score

Purpose:Open globe eye injuries can have profound social and economic consequences. Here, we describe two cases of war and outdoor activity open globe eye injury where, despite a low OTS score,.current microsurgical technology allowed for a favorable outcome.Case report 1: A 33-year-old Libyan soldier had been treated for an open-globe grenade blast trauma to his left eye, which showed light perception and OTS score 2..He had undergone a lensectomy and PPV with silicone oil tamponade. Surgical treatment included scleral buckling,.cornea trephination, temporary Eckardt keratoprosthesis, PPV revision, intraocular lens(IOL) implantation, and corneal grafting. Six months later, his VA was improved to 20 / 70.Case report 2:.A 35-year-old man presented with a corneal laceration in his left eye from a meat skewer,.with marked hypotony and LP..After primary corneal wound closure,.Bscan ultrasonography revealed massive vitreous hemorrhage(OTS score 2). The patient underwent open cataract extraction with IOL implantation, 23 gauge PPV, laser photocoagulation of the retinochoroidal laceration, and a gas tamponade. After three weeks,.the patient underwent a 2nd 23 G PPV due to a fibrinous reaction. Six month later, the patients exhibited 20 /25 VA.Conclusion:.These cases confirm that even for patients with a low OTS and poor visual prognosis,.an up-to-date surgery protocol may achieve visual results adequate for leading an autonomous daily life.

Combined Spinal Epidural Catheters for Epidural Cooling, Cerebrospinal Fluid Aspiration and Spinal Intralipid Infusion for Treatment of Spinal and Brain Injuries, Diseases and Protection

A new proposal for spinal cord and brain treatment and protection due to injuries and diseases is made herein. It is composed of two 20G nylon catheters with 6 lateral holes arranged circumferentially within 3 cm from the tip and a closed end. One catheter is inserted into the epidural space and the other catheter is inserted into the spinal space in two different lumbar interspaces using an 18G Tuohy needle 90 mm. The epidural catheter is used for cooled saline injection and infusion. The spinal catheter is used for Intralipid spinal injections and CSF aspiration. The proposal is based on the current studies on spinal cord cooling and CSF aspiration as well as on the Intralipid resuscitation properties and lipid brain protection. A study is needed to evaluate the clinical value of this combined approach.

Assessment of Social Participation in Three Measurement Times in Children with Traumatic Brain Injuries (TBI) Based on Parental Perceptions

Purpose: The aim of this study was to measure social participation in children with traumatic brain injuries (TBI) on their parental perceptions, retrospectively for the pre-injury period, at the beginning of rehabilitation and one year after return to school. Methods: This study was conducted among 17 children aged 5 to 17 years old with moderate or severe TBI and their parents. Social participation was assessed using the LIFE-H for Children (1.0). Results: A significant decrease (p ≤ 0.001) in the level of accomplishment of life habits was found for all categories between the measurements taken pre-injury and at the beginning of rehabilitation. Significant differences (p ≤ 0.002) related to the increase in the life habit accomplishment scores were also found between measurements taken at the beginning of rehabilitation and one year after return to school. Conclusion: TBI significantly affected the accomplishment of life habits of the participants compared to their pre-injury level. The assessment of social participation at various times provides a report on the client’s progress and allows clinicians to update his or her intervention plan, to plan follow-ups or to end the intervention. This knowledge must be considered by anyone involved in helping these children to achieve their greatest social participation.

Unmasking the responses of the stem cells and progenitors in the subventricular zone after neonatal and pediatric brain injuries

There is great interest in the regenerative potential of the neural stem cells and progenitors that populate the subventricular zone（SVZ）. However, a comprehensive understanding of SVZ cell responses to brain injuries has been hindered by the lack of sensitive approaches to study the cellular composition of this niche. Here we review progress being made in deciphering the cells of the SVZ gleaned from the use of a recently designed flow cytometry panel that allows SVZ cells to be parsed into multiple subsets of progenitors as well as putative stem cells. We review how this approach has begun to unmask both the heterogeneity of SVZ cells as well as the dynamic shifts in cell populations with neonatal and pediatric brain injuries. We also discuss how flow cytometric analyses also have begun to reveal how specific cytokines, such as Leukemia inhibitory factor are coordinating SVZ responses to injury.

Surgical Treatment of Traumatic Brain Injuries of Children in Abidjan: Difficulties, Results and Prospects

Introduction: Traumatic brain injury (TBI) in children is a common cause of emergency department admission to our institution. TBI constitutes a real public health problem in developed countries and marked increase in underdeveloped countries. The aim of this study was to evaluate the results of neurosurgical treatment of TBI in children at the neurosurgery department of Yopougon Teaching Hospital, while underlining the difficulties of the adequate management of this affection in Abidjan. Patients and Methods: It was a retrospective, descriptive monocentric study performed in the neurosurgery department, of Yopougon Teaching Hospital-Abidjan (Ivory Coast) from January 2000 to December 2017. We included all patients less than 16 years old admitted to the emergency department and all admitted in neurosurgery department for a TBI with a cerebral tomodensitometry and/or a magnetic resonance imaging having undergone a neurosurgical treatment. Results: During the study period 2825 cases of TBI in children aged less than 16 years old admitted to pediatric emergencies of our institution;among them 1020 (36%) presented clinical abnormalities and/or imaging. 292 (10.34%) children were hospitalized in neurosurgery department. 108 (36.9%) had surgical treatment. The mean age of patients was 7.8 ± 0.80 years with a male predominance (64%). Of the 108 children who had been operated on, 41 had acute extra-dural hematoma evacuation, 22 had a cranio-cerebral wound healing, 36 had a lift from a fracture depressing the skull and 9 had an acute subdural hematoma evacuation with a decompressive flap. The mean delay between diagnosis and surgical care was 104 ± 67.25 hours. The postoperative evolution at the last follow-up was favorable in 96 (88.8%) children with sequelae in 12 children (6 language disorders, 2 epileptic seizures and 4 motor deficits). The postoperative mortality rate was 11.2%. Conclusion: Ivory Coast Health System does not provide optimal care management of patients with TBI. There is an emerging imperative to develop an insurance system for the management of TBI.

Reduction in interhemispheric functional connectivity in the dorsal visual pathway in unilateral acute open globe injury patients: a resting-state fMRI study

This study investigated the changes in interhemispheric functional connectivity （FC） of the whole brain in open globe injury （OGI） patients, using voxel-mirrored homotopic connectivity （VMHC）, and their relationships with clinical features. Totally, 16 male and 2 female acute OGI patients and 18 sex, age, and education-matched healthy volunteers were enrolled in the study. All subjects were scanned through functional magnetic resonance imaging （fMRI）. Receiver operating characteristic （ROC） curves analyses had been used to identify the VMHC in these brain areas could be used as biomarkers to distinguish OGI and from healthy control （HC）. The mean VMHC values in multiple brain areas and clinical OGI manifestations were evaluated with a Pearson correlation analysis. OGI patients had significantly decreased VMHC in the bilateral calcarine/lingual/cuneus （BA18, 19, 30） and middle occipital gyrus （BA18, 19）. The OGI patients had abnormal interhemispheric FC in the dorsal visual pathway, which may represent the pathophysiological mechanism that underlies acute vision loss after OGI.

Contaminated open fracture and crush injury: a murine model

Modern warfare has caused a large number of severe extremity injuries, many of which become infected. In more recent conflicts, a pattern of co-infection with Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus has emerged. We attempted to recreate this pattern in an animal model to evaluate the role of vascularity in contaminated open fractures. Historically, it has been observed that infected bones frequently appear hypovascular, but vascularity in association with bone infection has not been examined in animal models. Adult rats underwent femur fracture and muscle crush injury followed by stabilization and bacterial contamination with A. baumannii complex and methicillin-resistant Staphylococcus aureus.Vascularity and perfusion were assessed by micro CT angiography and SPECT scanning, respectively, at 1, 2 and 4 weeks after injury. Quantitative bacterial cultures were also obtained. Multi-bacterial infections were successfully created, with methicillin-resistant S. aureus predominating. There was overall increase in blood flow to injured limbs that was markedly greater in bacteria-inoculated limbs. Vessel volume was greater in the infected group. Quadriceps atrophy was seen in both groups, but was greater in the infected group. In this animal model, infected open fractures had greater perfusion and vascularity than non-infected limbs.

Effects of the windshield inclination angle on head/brain injuries in car-to-pedestrian collisions using computational biomechanics models

Car-to-pedestrian collision(CPC)accidents occur frequently,and pedestrians often suffer serious head/brain injuries.One major cause is the primary impact with the windshield.Here,we use an umerical sim ulation method to study the influence of the windshield in-clination angle of a passenger car on pedestrian head/brain injury due to CPC accidents.The range of the windshield inclination angle was set at 24°-50°,with an interval of 2°.The results show that the windshield angle significantly affects the pedestrian kine-matics and exerts different effects on the head injury when evaluating with various head injury criteria.Regarding the head peak linear/rotational acceleration and acceleration-based head injury criterion(HIC)/rotational injury criterion(RIC),the predictions at the secondary impact stage have no clear relationship with the windshield angle(R^(2)=0.04,0.07,0.03 and 0.26,respectively)and their distributions are scattered.In the primary impact,the peak linear acceleration and HIC show a weak trend of first decreasing and then increasing with the increasing of the windshield angle,and the rotational acceleration and RIC tend to remain relatively con-stant.Regarding the cum ulative strain dama ge measure(CSDM)criterion,the predictions at the primary impact are slightly lower than those at the secondary impact,and the trend of first decreasing and then increasing with the increase in the windshield angle is observed at both impact stages.When the windshield inclination angle is approximately 32°-40°,the head injury severity in both impact phases is generally lower than that predicted at other windshield angles.

Does high intraocular pressure exclude an open globe injury?

Dear Sir,Ocular trauma is a topic of unresolved controversies and there are continuous controversial and debatable diagnostic and management strategies for open-globe injuries[1].Amongst many types of ocular trauma,the open globe injury is the most serious due to its very poor visual prognosis and young population of patients are mostly affected[2].The treatment outcome may be improved by prompt diagnosis,and immediate surgical repair performed to high standard[3].Amongst the other clinical signs the intraocular pressure(IOP)is found to be particularly reduced and conventionally this is considered as a very reliable indicator of occult globe

RELEASE OF SERUM TROPONIN I AND ITS RELATIONSHIP TO MULTIFACTORS FOLLOWING OPEN HEART SURGERY IN CHILDREN

Objective To be released specifically after myocardial damage. The goal of this study was to measure serum cardiac troponin I levels after open heart surgery in children, and to evaluate relevance between TnTi and perioperative multi-factors. Methods Fifty-seven consecutive pediatric patients undergoing elective correction of congenital heart diseases were divided into group A （ TOF, n =31 ） and group B （ VSD, n =26）. Blood sampies were drawn preoperatively, 5min（ T0 ） , 6h（ T6 ） , 12h（ T12 ） , 24h（ T24 ） , 48h（ T48 ） , 72h（ T72 ） after removal of aortic cross clamping. Myocardial protection consisted of moderate systemic hypothermia （ 30℃- 32℃ ）, cold crystalloid cardioplegia and topical cooling. Demographic information, cardiac defect, repair procedure, duration of bypass （ CPBT） , cross-clamping time （ CCT） , clinical score for cardiac function, electrocardiographic changes and outcomes were recorded. Results Compared with the baseline value, serum concentration of troponin I peaked at T0 （ P 〈 0. 01 ）, and fell to normal level at T72 （ P 〉 0. 05 ）. Peak CTnI was 118 and 55 times higher than the baseline value, respectively in group A and group B. There was a positive correlation between peak CTnI and CPBT, CCT （ r = 0. 51 ; P 〈 0. 01 ）, myocardial operative injury after ventriculotomy and muscle resection （ r = 0. 35, P 〈0. 01 ）. Also the peak CTnl value was correlated to the clinical score for cardiac function （r = -0. 52; P 〈0. 01）. 2.3μg/L was a cutoff value which was highly predictive for postoperative recovery and inotropic support. Conclusion Postoperative serum troponin I is a highly specific and sensitive marker for myocardial ischemia and injury; therefore, its measurement may contribute to the assessment of recovery and outcome after open heart surgery.

Poor prognostic factors in post-traumatic endophthalmitis following open globe injury

AIM:To demonstrate prognostic factors for poor visual outcome in patients with post-traumatic endophthalmitis(PTE)following open globe injury.METHODS:A retrospective study was conducted on 66 patients(66 eyes)with PTE following open globe injury from 2005 to 2015.Potential factors accounting for good and poor visual outcome were statistically analyzed by Chisquare test and Logistic regression model.RESULTS:In 66 cases,39 cases(59%)had a poor visual outcome.Univariate and multivariate Logistic regression analysis identified retained intraocular foreign body(IOFB)as the only factor significantly associated with poor visual outcome[adjusted odds ratio,4.62;95%confidence interval(1.04-20.53);P=0.04].The most common causative agents were gram-positive organisms(83%),of which Bacillus cereus(33%),was the most common pathogen.All cases received intravitreal antibiotic injections.Oral ciprofloxacin was the most used systemic antibiotic(33%).Pars plana vitrectomy was performed in 83%(55/66)of cases.At 6 mo follow-up,mean BCVA was 1.74±0.72 log MAR units.CONCLUSION:In patients with PTE following open globe injury,the only predictor of poor visual outcome is the presence of IOFB.Bacillus cereus is the most isolated microorganism.