Study on cumulative effects of biological craniocerebral trauma under repeated blast

Repeated blast impacts on personnel in explosive environments can exacerbate craniocerebral trauma.Most existing studies focus on the injury effects of a single blast,lacking in-depth analysis on the injury effects and cumulative effects of repeated blasts.Therefore,rats were used as the experimental samples to suffer from explosion blasts with different peak air overpressures(167 kPa~482 kPa)and varying number of repeated blasts.The cumulative effect of craniocerebral trauma was most pronounced for moderate repeated blast,showing approximately 95%increase of trauma severity with penta blast,and an approximately 85%increase of trauma severity with penta minor blast.The cumulative effect of craniocerebral trauma from severe,repeated blast has a smaller rate of change compared to the other two conditions.The severity of trauma from penta blast increased by approximately 69%compared to a single blast.Comprehensive physiological,pathological and biochemical analysis show that the degree of neurological trauma caused by repeated blasts is higher than that of single blasts,and the pathological trauma to brain tissue is more extensive and severe.The trauma degree remains unchanged after double blast,increases by one grade after triple or quadruple blast,and increases by two grades after penta blast.

Endoscopy-assisted vitrectomy for severe ocular penetrating trauma with corneal opacity

AIM:To assess the utility and efficiency of endoscopyassisted vitrectomy(EAV)for the treatment of corneal opacity in severe ocular trauma.METHODS:Patients who underwent fundus examination using a preoperative slit lamp and intraoperative endoscopy,followed by EAV and additional surgery were retrospectively recruited.Silicone oil removal and penetrating keratoplasty were used in selected eyes at postoperative follow-ups.Outcome measurements included the best corrected visual acuity(BCVA),intraocular pressure(IOP),findings of endoscopic fundus examination,and postoperative complications.RESULTS:Twenty-one eyes with severe ocular trauma and corneal opacity were followed up for 24-36mo.Retinal detachment(RD)and vitreous haemorrhage(VH)were identified in 16 eyes(76.2%),RD only in four eyes(19.0%),and VH combined with intraocular foreign body in one eye(4.8%).All eyes underwent at least three surgeries.Stage-Ⅰ surgeries involved wound closure(100%),lens extraction(76.2%),and anterior vitrectomy(14.3%).Stage-Ⅱ surgeries involved scleral buckling(28.6%),membrane peeling(47.6%),retinal laser photocoagulation(100%)and silicone oil tamponade(100%)using EAV.Stage-Ⅲ surgeries were conducted using endoscopy including silicone oil removal(52.4%),retinal laser photocoagulation(52.4%)and penetrating keratoplasty(28.6%).Nearly all eyes showed improvements in BCVA and IOP.Although there were no severe complications,glaucoma was noted in one eye,chronic hypotony in another eye,and band keratopathy in three eyes.CONCLUSION:EAV is an effective adjunct for restoring ocular anatomical structures and visual function in the case of corneal opacity after severe ocular trauma.

Management of Penetrating Cranioencephalic Trauma Caused by Sharp Metal Objects—Therapeutic and Evolutionary Aspects: 12 Cases at the Renaissance University Hospital in N’Djamena

Introduction: Cranioencephalic trauma caused by bladed weapons is rare, and that caused by sharp objects is exceptional. The aim of our study was to describe the clinical, therapeutic and evolutionary aspects. Materials and method: This was a descriptive and analytical study over a 48-month period at CHU la Renaissance from January 1, 2018 to December 31, 2021, concerning patients admitted for penetrating cranioencephalic trauma by pointed object. Results: Twelve cases, all male, of penetrating cranioencephalic sharp-force trauma were identified. The mean age was 34 ± 7 years, with extremes of 11 and 60 years. Farmers and herders accounted for 31% and 25% of cases respectively. The average admission time was 47 hours. Brawls were the circumstances of occurrence in 81.2% of cases. Knives (33%), arrows (25%) and iron bars (16.6%) were the objects used. Altered consciousness was present in 43.8% of cases, and focal deficit in 50%. Scannographic lesions were fracture and/or embarrhment (12 cases), intra-parenchymal haematomas (6 cases) and presence of object in place (4 cases). Surgery was performed in 11 patients. Postoperative outcome was favorable in 9 patients. After 12 months, 2 patients were declared unfit. Conclusion: Penetrating head injuries caused by sharp objects are common in Chad. Urgent surgery can prevent disabling after-effects.

Delayed Pseudoaneurysms of Vertebral Artery Post Penetrating Trauma: A Case Report

Objective: Vascular injuries usually present immediately after the penetration, but the delayed onset of vascular symptoms caused by vessel dissection or aneurysm after a traumatic event is extremely rare. Vertebral artery injury is a low-frequency but high-mortality injury. We aim to report evidence of delayed onset of vascular symptoms following penetrating trauma in the neck. Materials and Methods: A case report. Results: A 19-year-old boy was referred to our hospital and complained of a mass in the right part of his neck (right mandibular angle). He gave a history of penetrating trauma to his neck 2 months ago. The mass was expanding during these 2 months and doesn’t respond to antibiotic therapy. In the examination, 3 × 3 cm, firm, nonmobile, and without tenderness and pain mass was palpated in the second level of his neck. Doctors ordered a Doppler sonography in the hospital where a yin-yang pattern was reported. A 36 × 43 × 40 mm heterogeneous, solid, and hypodense area close to C1-C2-C3 with vascular flow was discovered in the right submandibular area after computed tomography (CT)-angiography. The patient was referred to an interventional neurologist for angiography and due to the lack of flow at the distal of the V3 segment, he decided to sacrifice this artery by two coils. Conclusion: Penetrating neck injuries are usually asymptomatic, but these injuries are often accompanied by hemorrhage, neurological symptoms, dysphagia, odynophagia, and windpipe. Penetrating lesions of the vertebral artery are rare and very difficult to diagnose. Also, these lesions are challenging for surgeons due to complex anatomy and difficult surgical exposure. So, endovascular treatment was used to treat the patient.

Steel bar penetrating cervical spinal canal without neurological injury:A case report

BACKGROUND We report a rare case of cervical spinal canal penetrating trauma and review the relevant literatures.CASE SUMMARY A 58-year-old male patient was admitted to the emergency department with a steel bar penetrating the neck,without signs of neurological deficit.Computed tomography(CT)demonstrated that the steel bar had penetrated the cervical spinal canal at the C6–7 level,causing C6 and C7 vertebral body fracture,C6 left lamina fracture,left facet joint fracture,and penetration of the cervical spinal cord.The steel bar was successfully removed through an open surgical procedure by a multidisciplinary team.During the surgery,we found that the cervical vertebra,cervical spinal canal and cervical spinal cord were all severely injured.Postoperative CT demonstrated severe penetration of the cervical spinal canal but the patient returned to a fully functional level without any neurological deficits.CONCLUSION Even with a serious cervical spinal canal penetrating trauma,the patient could resume normal work and life after appropriate treatment.

Changes in platelet parameters and secondary brain injury in acute craniocerebral trauma

Changes in platelet parameters are important in secondary brain injury in acute craniocerebral trauma We selected 163 patients with craniocerebral trauma who were admitted within 24 hours with nonoperative therapy. Platelet parameters of 40 healthy subjects served as controls. Platelet number was decreased, while mean platelet volume and platelet distribution width values were increased, at 1 and 3 days after injury. Platelet number was lower and mean platelet volume and platelet distribution width were larger in patients with traumatic cerebral infarction and those in Glasgow Coma Scale score 〈 8 group. Platelet number was negatively correlated to volume of cerebral edema, but positively correlated to Glasgow Outcome Scale score. These data indicate that changes in platelet parameters may be utilized to indicate the state of central nervous system injury and patient prognosis .

Effects of Continuous Nursing Intervention on Postoperative Rehabilitation of Patients with Craniocerebral Trauma

Objective:To study and analyze the clinical effect of continuous nursing in the process of postoperative rehabilitation for patients with craniocerebral trauma.Methods:From August 2018 to July 2021,40 patients who came to our hospital for craniocerebral trauma treatment were randomly selected as clinical experimental research objects,and they were divided into continuous nursing group and routine nursing group.The rehabilitation of patients in the two groups before and after postoperative nursing was observed and counted.Results:Before nursing intervention,there was no significant difference in MMSE score and Fugl-Meyer score between the two groups,p>0.05.After nursing,the scores were scored again at 3 and 6 months after nursing.It was found that the two groups were improved,but the improvement range in the continuous nursing group was significantly higher than that in the routine nursing group,the difference was statistically significant(p<0.05).From the score of quality of life,the scores of physical pain,psychological function,mental health and social function in the continuous nursing group were better than those in the routine nursing group,the difference was statistically significant(p<0.05).Conclusion:Using continuous nursing measures for rehabilitation nursing of patients with craniocerebral trauma after discharge can significantly improve the quality of life of patients,restore the mental state and limb function of patients,and has significant clinical effect.

Craniocerebral trauma

210234 Regulating effects of the ERK1/2 signaling pathway on neurons apoptosis after diffuse brain injury in rats/Zhao Yaning(赵雅宁,Basic Med Dept,North Chin Coal Med Col,Tangshan 063000)…Chin J Neurosurg.-2010,26(1).

Craniocerebral trauma

209379 Calpain expression changes in response to hypothermia after traumatic brain injury/Wan Jieqing(万杰清,Dept Neurosurg,Renji Hosp,School Med,Shanghai Jiaotong Univ,Shanghai 200127)…∥Chin J Traum.-2009,25(6).-507～509Objective To determaine the effect of hypothermia on gene transcription and protein expression of calpain after traumatic brain injury(TBI).Methods Twenty-seven rats were randomly divided into three groups,ie,normal control group,normothermia TBI group and hypothermia TBI group.All rats with TBI suffered from a lateral fluid percussion injury(FPI)at the right parietal lobe.Hypothermia intervention[rectal temperature for(32±0.5)℃]was performed for four hours immediately after TBI in hypothermia TBI group.Fluorescence PCR and Western blot were utilized to semi-quantify gene transcription and protein expression of calpain and immunofluorescence used to observe protein distribution of Calpain.Results Compared with normothermia TBI group and normal control group,hypothermia TBI group showed increased calpain gene transcription at 12 and 24 hours respectively after FPI (P【0.05).However,the increase of calpain protein expression in hypothermia TBI group was inhibited more significantly by hypothermia at 6,12,24 and 72 hours after TBI,compared with normothermia TBI group(P【0.05).Conclusion Neuroprotection of hypothermia after TBI may somewhat be related to the decrease of calpain protein expression after its gene transcription.10 refs,1 fig,2 tabs.

Intentional Penetrating Craniocerebral Injury Caused by a Nail: Clinical Presentation and Management of Three Cases

The authors report on their experience in the medical and surgical management of three cases of penetrating craniocerebral injuries caused by a nail. In all three cases, it was an aggression. Two of the three patients were male. The cranial locations affected were respectively left parietal, right temporal and right frontal. The Glasgow coma score (GCS) was between 9 and 13. None of the patients had a motor deficit. A plain skull radiographs was performed for each patient. All patients underwent surgery and all received antibiotic therapy and tetanus vaccination. In two cases, post-operative outcome was simple. Recovery was complete without sequelae. The patient with a GCS of 9 died the day after surgery.

Cerebral Fat Embolism Syndrome from Penetrating Trauma: A Rare Cause-and-Effect

A 42 year-old male sustained an accidental rifle gunshot wound to his left foot, resulting in fracture deformities of the calcaneus, navicular, cuneiform, 1st and 2nd metatarsal bases, and talus. As he was transported to our trauma center, he developed progressive encephalopathy. Urgent external fixator placement under general anesthesia was postponed due to his encephalopathy of unknown etiology. Brain magnetic resonance imaging demonstrated a “starfield” pattern of infarcts, consistent with cerebral fat embolism syndrome. Subsequently, he underwent uneventful general anesthesia. The patient was managed supportively and continued to have persistent neurologic dysfunction two months after injury.

Management and outcome of bronchial trauma due to blunt versus penetrating injuries

BACKGROUND The number of patients with bronchial trauma(BT)who survived to hospital admission has increased with the improvement of prehospital care;early diagnosis and treatment should be considered,especially among blunt trauma patients,whose diagnosis is frequently delayed.AIM To describe the early recognition and surgical management considerations of blunt and penetrating BTs,and to elaborate the differences between them.METHODS All patients with BTs during the past 15 years were reviewed,and data were retrospectively analyzed regarding the mechanism of injury,diagnostic and therapeutic procedures,and outcomes.According to the injury mechanisms,the patients were divided into two groups:Blunt BT(BBT)group and penetrating BT(PBT)group.The injury severity,treatment procedures,and prognoses of the two groups were compared.RESULTS A total of 73 patients with BT were admitted during the study period.The proportion of BTs among the entire cohort with chest trauma was 2.4%(73/3018),and all 73 underwent thoracotomy.Polytrauma patients accounted for 81.6% in the BBT group and 22.9%in the PBT group,and the mean Injury Severity Score was 38.22±8.13 and 21.33±6.12,respectively.Preoperative three-dimensional spiral computed tomography(CT)and/or fiberoptic bronchoscopy(FB)were performed in 92.1% of cases in the BBT group(n=38)and 34.3% in the PBT group(n=35).In the BBT group,a delay in diagnosis for over 48 h occurred in 55.3% of patients.In the PBT group,31 patients underwent emergency thoracotomy due to massive hemothorax,and BT was confirmed during the operation.Among them,22 underwent pulmo-tractotomy for hemostasis,avoiding partial pneumonectomy.In this series,the overall mortality rate was 6.9%(5/73),and it was 7.9%(3/38)and 5.7%(2/35)in the BBT group and PBT group,respectively(P>0.05).All 68 survivors were followed for 6 to 42(23±6.4)mo,and CT,FB,and pulmonary function examinations were performed as planned.All patients exhibited normal lung function and healthy conditions except three who required reoperations.CONCLUSION The difference between blunt and penetrating BTs is obvious.In BBT,patients generally have no vessel injury,and the diagnosis is easily missed,leading to delayed treatment.The main cause of death is ventilation disturbance due to tension pneumothorax early and refractory atelectasis with pneumonia late.However,in PBT,most patients require emergency thoracotomy because of simultaneous vessel trauma and massive hemothorax,and delays in diagnosis are infrequent.The leading cause of death is hemorrhagic shock.

Black diaphragm intraocular lens implantation and penetrating keratoplasty in aphakic eyes with traumatic aniridia

AIM:To evaluate the long-term outcome of implantation of black diaphragm intraocular (BDI) lens combined with penetrating keratoplasty (PKP) for managing aphakic eyes with traumatic aniridia and corneal damage. METHODS: Six aphakic eyes of six patients with traumatic aniridia and corneal damage had BDI lens implantation at Qingdao Eye Hospital, Shandong Eye Institute from June 2008 to November 2011. Medical records of the patients were reviewed. Three patients received PKP and after 12-18months were implanted with BDI lens. The other three patients completed PKP and BDI lens implantation at the same time. The corrected visual acuity, intraocular pressure and number of corneal endothelial cells were monitored. RESULTS: The patients were followed up for an average of 24.3 ±12.1months (range 14-48 months). All BDI lenses were located well. The best corrected visual acuity got improved in 5 patients (0.1-1.0) and decreased in 1 patient from 0.4 to 0.2. Three patients had normal intraocular pressure (IOP) after implantation. Two patients required antiglaucoma medications to control IOP within the normal range and 1 patient implanted Ahmed glaucoma valve to control IOP. The corneal grafts kept transparent in all eyes and the corneal endothelial counting 】1 000/mm2 , although two patients experienced acute graft rejection and loss more than 30% corneal endothelial cells.CONCLUSION: Implantation of BDI lens combined with PKP is an effective option for managing aphakic eyes with traumatic aniridia and corneal damage. Although the results in our study are encouraging, additional studies of the long -term safety and efficacy are required. Alarger study population and longer follow-up may be beneficial.

Contralateral hemopneumothorax after penetrating thoracic trauma:A case report

BACKGROUND Trauma is the leading cause of death in young adults up to the age of 45 years.Hemothorax is a frequent consequence of penetrating thoracic trauma,and is usually associated with pneumothorax and pneumoderma.Intercostal arterial bleeding or intrathoracic hemorrhage occurs after penetrating thoracic trauma,and uncontrolled bleeding is the main cause of death.CASE SUMMARY In this case report,a patient who developed a right hemopneumothorax after penetrating thoracic trauma was examined.A 19-year-old male patient,who was brought to the emergency room with a penetrating stab injury to the posterior of the left hemithorax,was diagnosed with a right hemopneumothorax after physical examination and thoracic imaging.Chest tube thoracostomy was performed as the initial intervention.Bleeding control was achieved with right posterolateral thoracotomy in the patient,who developed massive hemorrhage after 1 h and hemodynamic instability.The patient recovered and was discharged on the fourth postoperative day.CONCLUSION Contralateral hemopneumothorax that accounts for 30%of thoracic traumas and can be encountered in penetrating thoracic traumas requiring major surgery in 15-30%of cases was emphasized and the contralateral development mechanism was addressed.

Correlation of serum CNP and IGF-Ⅱ contents with brain injury and inflammatory response in patients with craniocerebral trauma

Objective:To study the correlation of serum C-type natriuretic peptide (CNP) and insulin-like growth factor-Ⅱ (IGF-Ⅱ) contents with brain injury and inflammatory response in patients with craniocerebral trauma.Methods: Patients with craniocerebral trauma who were treated in the First Affiliated Hospital of Xi'an Jiaotong University between March 2015 and July 2017 were included in the case group of the study, and the healthy volunteers who received physical examination during the same period were included in the control group. The contents of CNP, IGF-Ⅱ, nerve markers and pro-inflammatory cytokines in serum as well as the expression of inflammatory signaling molecules in peripheral blood were measured.Results: CNP and IGF-Ⅱ contents in serum of case group were significantly lower than those of control group whereas UCH-L1, GFAP, S100B, Tau, MIP-1α, IL-1β, IL-6, IL-8 and TNF-α contents in serum as well as JAK2, STAT3, MEK and ERK1/2 mRNA expression in peripheral blood were significantly higher than those of control group;CNP and IGF-Ⅱ contents in serum of case group were negatively correlated with UCH-L1, GFAP, S100B, Tau, MIP-1α, IL-1β, IL-6, IL-8 and TNF-α contents in serum as well as JAK2, STAT3, MEK and ERK1/2 mRNA expression in peripheral blood.Conclusion: The decrease of serum CNP and IGF-Ⅱ in patients with craniocerebral trauma is closely related to the aggravation of brain injury and the over-activation of inflammatory response.

Effects of propofol anesthesia on oxidative stress, neurological function and inflammatory cytokines in patients with craniocerebral trauma

Objective: To investigate the effect of propofol anesthesia on oxidative stress, neurological function and inflammatory cytokines in patients with craniocerebral trauma. Methods: A total of 102 patients with craniocerebral trauma who underwent surgery in our hospital from December 2014 to January 2017 were randomly divided into control group and observation group, each contained 51 cases. The control group was given 1%-2% of sevoflurane and 0.1-0.2 μg/kg/min of remifentanil and 20-30 μg/kg/h of vecuronium for anesthesia maintenance. The observation group was given propofol 4-6 mg/kg/h, remifentanil 0.1-0.2 μg/kg/min and vecuronium 20-30 μg/kg/h for anesthesia maintenance. The levels of oxidative stress, neurological function, and inflammatory factors were assessed in both groups. Results:Compared with before treatment, the levels of SOD and HO-1 in the two groups were significantly increased and the levels of MDA were significantly decreased, the difference was significant, and the levels of SOD and HO-1 in the observation group were significantly higher than control group, the level of MDA was significantly lower than that of the control group, the difference was significant. Compared with before treatment, the levels of NSE, GFAP and Tau level were significantly decreased in the two groups after treatment, and level in observation group was lower than control group, the difference was statistically significant. Compared with before treatment, the levels of IL-6, TNF-α and CRP in the two groups after treatment were significantly lower than those in the control group, the difference was statistically significant. Conclusion: Propofol anesthesia can significantly reduce the oxidative stress injury, inhibit the inflammatory reaction and protect the neurological function of patients. The effect is better than isoflurane anesthesia, and it is worthy of clinical application.

Relationship of Nogo-A gene expression in serum and cerebrospinal fluid with nerve injury and inflammatory factor levels in patients with craniocerebral trauma

Objective:To study the relationship of Nogo-A gene expression in serum and cerebrospinal fluid with nerve injury and inflammatory factor levels in patients with craniocerebral trauma. Methods:82 patients with craniocerebral trauma who were treated in our hospital between January 2015 and February 2017 were collected as observation group, and 58 normal subjects who received internal hemorrhoids surgery under lumbar anesthesia in our hospital during the same period were collected as control group. Fluorescence quantitative PCR method was used to detect Nogo-A gene expression in serum and cerebrospinal fluid of both groups, and enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of nerve injury indexes and inflammatory factors in two groups. Pearson test was used to assess the relationship of Nogo-A gene expression in serum and cerebrospinal fluid with disease severity in patients with craniocerebral trauma.Results: Nogo-A mRNA expression in the serum and cerebrospinal fluid of observation group were higher than those of the control group;serum IGF-Ⅱ level was lower than that of control group while NSE, MBP and S100B levels were higher than those of control group;serum HSP-70, PCT, IL-1β, IL-6 and CRP levels were higher than those of control group. Pearson test showed that Nogo-A gene expression in serum and cerebrospinal fluid of patients with craniocerebral trauma were directly correlated with the nerve injury degree and inflammatory factor levels.Conclusions: Nogo-A gene is highly expressed in patients with craniocerebral trauma, and its expression is directly correlated with the nerve injury and systemic inflammatory response.

Effect of propofol and isoflurane general anesthesia on nerve injury in patients with craniocerebral trauma after emergency surgery

Objective: To study the effect of propofol and isoflurane general anesthesia on nerve injury in patients with craniocerebral trauma after emergency surgery. Methods: Patients with craniocerebral trauma who accepted emergency surgery in Dangyang People's Hospital between May 2015 and February 2017 were selected and randomly divided into propofol group and isoflurane group who received propofol + fentanyl + vecuronium bromide as well as isoflurane + fentanyl + vecuronium bromide anesthesia respectively. Serum levels of nerve injury markers, excitatory amino acids, inhibitory amino acids and oxidative stress indicators were detected before operation, immediately after operation and 12 h after operation. Results:Immediately after operation and 12 h after operation, serum NSE, GFAP, NGB, Tau, GLU, ASP, 8-iso-PGF2 and MDA levels of both groups of patients were significantly lower than those before operation while GABA, ALA, HO-1, NQO-1 and SOD levels were significantly higher than those before operation, and serum NSE, GFAP, NGB, Tau, GLU, ASP, 8-iso-PGF2 and MDA levels of propofol group immediately after operation and 12 h after operation were significantly lower than those of isoflurane group while GABA, ALA, HO-1, NQO-1 and SOD levels were significantly higher than those of isoflurane group. Conclusion: Propofol for emergency surgery of patients with craniocerebral trauma is more effective than isoflurane in alleviating nerve injury degree, correcting the excitatory and inhibitory amino acid disorder, and inhibiting oxidative stress reaction.

Frontal penetrating arrow injury:A case report

BACKGROUND Penetrating arrow injuries of the head and neck are exceedingly rare in pediatric patients.This pathology has high morbidity and mortality because of the presence of vital organs,the airway,and large vessels.Therefore,the treatment and removal of an arrow is a challenge that requires multidisciplinary management.CASE SUMMARY A 13-year-old boy was brought to the emergency room after an arrow injury to the frontal region.The arrowhead was lodged in the oropharynx.Imaging studies showed a lesion of the paranasal sinuses without compromising vital structures.The arrow was successfully removed by retrograde nasoendoscopy without complications,and the patient was discharged.CONCLUSION Although rare,maxillofacial arrow injuries have high morbidity and mortality and require multidisciplinary management to preserve function and aesthetics.

RELATIONSHIP BETWEEN THE COURSE OF THE DISEASE AND P_300 OF PATIENTS WITH CLOSED CRANIOCEREBRAL TRAUMA

目的:研究闭合性颅脑外伤患者病程与P300之间的关系,并探讨作P300测定的最佳时间。方法:应用Medicid-03E脑诱发电位仪测定518例闭合性颅脑外伤患者的视觉刺激诱发的P300波之潜伏期和波幅。结果:病人组P300波潜伏期较正常对照组明显延长,波幅也明显降低。结论:P300波的变化可作为判断闭合性颅脑外伤患者脑认知功能变化的一项客观指标。