A Review of Nurses’ Perceptions of Traumatic Haemorrhagic Shock Management in Emergency Nursing

Haemorrhagic shock (HS) is a subset of hypovolaemic shock in which there is minimal to massive loss of blood either internally or externally in trauma or injured patients. Data from the World Health Organization (WHO) affirm that injuries account for over 5 million fatalities globally every year, and by 2030, injury mortality is predicted to rise severely. Public health research typically uses the KAP models, which may be divided into three parts: acquiring accurate knowledge, forming an attitude, and adopting behavior, to analyze people’s health behaviors and explain changes in them. This review is about the nurses’ perspectives of the concept of Knowledge, Attitude, and Practice (KAP) Model of hemorrhagic shock in trauma patients and assesses clinical practice tools used by nurses to keep an eye on patients who have the condition. Nurses’ knowledge of indications of shock is either high or very high. The knowledge of nurses was related to their training before working in accident and emergency units. The nurses’ attitude is considered significant, commendable, appropriate, and pertinent to the provision of care for a patient experiencing hemorrhagic shock. And the nurse’s practice of early patient identification, prompt and continuous monitoring, control of the bleeding source, maintenance of hemostasis, and the correction of significant blood loss that can occur quickly to cause death, are the strengths of management. .

Clinical Effects of Intensive Insulin Therapy Treating Traumatic Shock Combined with Multiple Organ Dysfunction Syndrome

The therapeutic effects of intensive insulin therapy in treatment of traumatic shock combined with multiple organ dysfunction syndrome （MODS） were investigated. A total of 114 patients with traumatic shock combined with MODS were randomly divided into two groups： control group （n=56） treated with conventional therapy, and intensive insulin therapy group （n=58） treated with conventional therapy plus continuous insulin pumping to control the blood glucose level at range of 4.4-6.1 mmol/L. White blood cells （WBC） counts, prothrombin time （PT）, serum creatinine （SCr）, alanine aminotransferase （ALT）, serum albumin and PaO2 were measured before and at the day 1, 3, 5, 7 and 14 after treatment. The incidence of gastrointestinal dysfunction, the incidence of MODS, hospital stay and the mortality were also observed and compared. After intensive insulin therapy, the WBC counts, SCr, ALT and PT were significantly reduced （P0.05）, but the level of serum albumin was significantly increased （P0.05） at the day 3, 5, 7 and 14. In the meantime, the PaO2 was significantly elevated at the day 3, 5 and 7 （P0.01） after intensive insulin therapy. The incidence of gastrointestinal dysfunction, the incidence of MODS, the length of hospital stay and the mortality were markedly decreased （P0.01）. The results suggest early treatment with intensive insulin therapy is effective for traumatic shock combined with MODS and can decrease the length of hospital stay and the mortality.

Correlation between heat shock protein 70 expression in the brain stem and sudden death after experimental traumatic brain injury

Objective:Theaimof thisstudywas to determinethepatternsof heat-shockprotein70(HSP 70 )biosynthesis followingtraumaticbraininjury,andobservetheeffectof HSP 70 inductionon thefunctionof thevitalcenterinthebrain stem.Methods:Ratmodelsof suddendeathresultedformtraumaticbraininjurywereproduced,andHSP 70 expressionin theratbrainstemwasdeterminedby immunohistochemistry,theinductionof HSP 70 mRNAdetectedby RT-PCR.Re -sults: Thelevelof HSP 70 mRNAwasprominentlyelevatedinthebrainstemas earlyas15minfollowingtheimpactin-jury,whileHSP 70 expressionwasonlyobserved3to6h aftertheinjury.Itwasalsoobservedthatthelevelsof HSP 70 mR-NAbutnottheproteinwereelevatedinthebrainstemof suddendeathrats.Conclusion:Thesynthesisof HSP 70 wassig-nificantlyenhancedinthebrainstemfollowingtraumaticinjury,andtheexpressionof HSP 70 is beneficialto eliminatethe stressagents,andto sustainthecellularproteinhomeostasis.Whentheinjurydisturbsthesynthesisof HSP 70 to disarmthe protectivemechanismof heat-shockproteins,dysfunctionof thevitalcenterinthebrainstem,andconsequentlydeathmay occur.Breachinthesynchronizationof HSP 70 mRNA-proteincanbeindicativeof fataldamageto thenervecells.

Hypopituitary syndrome with pituitary crisis in a patient with traumatic shock:A case report

BACKGROUND Shock is among the most common conditions that clinicians face in intensive care unit(ICU),of which hypovolemic shock is encountered most frequently;some patients instead suffer from neurogenic,cardiogenic,or infectious forms of shock.However,there are additional types of shock from unusual causes that are often undiagnosed.Here,we report the case of a patient who was initially misdiagnosed with hypovolemic shock,but exhibited persistent hypotension because of continuous fluid replacement and vasoactive drug administration,and was eventually diagnosed with hypopituitarism with crisis.CASE SUMMARY A 73-year-old Chinese man was admitted to the neurosurgery department following injury caused by a heavy object with symptoms of anemia and high fever.He was transferred to the ICU on the fourth day after hospitalization because of hypotension and unconsciousness.Blood analysis indicated that the patient was suffering from anemia and thrombocytopenia.Ultrasonography showed that there was no apparent abnormality in the cardiac structure but there was mild tricuspid regurgitation.Computed tomography revealed that there were signs of hemorrhage at the right basal ganglia;accordingly,hypovolemic shock,possibly septic shock,was initially considered.Even after routine treatment for shock,the hypotension remained severe.The patient was again thoroughly examined to investigate the underlying cause.The antishock therapy was supplemented with corticosteroids to counter potential hypopituitarism.The patient made a full recovery,and the blood pressure returned to normal.CONCLUSION A case of pituitary adenoma with multiple injuries was identified.Because of hypopituitarism,functionality of the corresponding endocrine system was restricted,with the most pronounced manifestation being unstable blood circulation requiring hormone replacement therapy.Such cases are relatively rare but may occur if multiple injuries are sustained.The present case represents a reference for the clinical treatment of patients with multiple injuries.

Connecting cellular mechanisms and extracellular vesicle cargo in traumatic brain injury

Traumatic brain injury is followed by a cascade of dynamic and complex events occurring at the cellular level. These events include: diffuse axonal injury, neuronal cell death, blood-brain barrier break down, glial activation and neuroinflammation, edema, ischemia, vascular injury, energy failure, and peripheral immune cell infiltration. The timing of these events post injury has been linked to injury severity and functional outcome. Extracellular vesicles are membrane bound secretory vesicles that contain markers and cargo pertaining to their cell of origin and can cross the blood-brain barrier. These qualities make extracellular vesicles intriguing candidates for a liquid biopsy into the pathophysiologic changes occurring at the cellular level post traumatic brain injury. Herein, we review the most commonly reported cargo changes in extracellular vesicles from clinical traumatic brain injury samples. We then use knowledge from animal and in vitro models to help infer what these changes may indicate regrading cellular responses post traumatic brain injury. Future research should prioritize labeling extracellular vesicles with markers for distinct cell types across a range of timepoints post traumatic brain injury.

Albumin resuscitation protects against traumatic/hemorrhagic shock-induced lung apoptosis in rats

Objective: To determine the effects of albumin administration on lung injury and apoptosis in traumatic/hemorrhagic shock (T/HS) rats. Methods: Studies were performed on an in vivo model of spontaneously breathing rats with induced T/HS; the rats were subjected to femur fracture, ischemia for 30 min, and reperfusion for 20 min with Ringer's lactate solution (RS) or 5% (w/v) albumin (ALB), and the left lower lobes of the lungs were resected. Results: Albumin administered during reperfusion markedly attenuated injury of the lung and decreased the concentration of lactic acid and the number of in situ TdT-mediated dUTP nick-end labelling (TUNEL)-positive cells. Moreover, immunohistochemistry performed 24 h after reperfusion revealed increases in the level of nuclear factor κB (NF-κB), and phosphorylated p38 mitogen-activated protein kinase (MAPK) in the albumin-untreated group was down-regulated by albumin treatment when compared with the sham rats. Conclusion: Resuscitation with albumin attenuates tissue injury and inhibits T/HS-induced apoptosis in the lung via the p38 MAPK signal transduction pathway that functions to stimulate the activation of NF-κB.

Effect of preoperative limited fluid resuscitation to the patients with traumatic shock

Objective:To investigate the effect of preoperative limited fluid resuscitation on the patients with traumatic shock.Methods:Eighty-nine patients with multiple injuries complicating with shock were treated in Changhai Hospital between January 2002 to October 2005 and were divided into 3 groups accord ing to the preoperative levels of systolic blood pressure(SBP).SBP of group A and group B were about 70 and 80 mmHg,respectively;and the SBP of group C was over 90 mmHg.Results:(1)There was no sig- nificant difference in age,gender,and injury severity score(ISS),initiated resuscitation time and initiated operation time among the 3 groups.Preoperatively,there was significant difference in the amount of fluid resuscitation and infused erythrocyte suspension among group A,B and C(1687±96 ml,2096±87 ml. 2976±93 ml,P<0.05;and 294±110ml,404±113 ml,7984±230ml,P<0.05).(2)The hemoglobin level in group C(94±45 g/L)was lower than that in group A(110±22 g/L)and group B(103±24 g/L)(P<0.05).However,there was no significant difference in the level of hemoglobin between group A and B.(3)There was no significant difference in the incidence of acute renal failure(ARF)among the 3 groups.The incidence of acute respiratory distress syndrome(ARDS)of group C(31.2%)was higher than that of group A(16.7%)and group B(18.2%)(P<0.05).The mortality of group C(34.4%)was higher than that of group A(12.5%)and group B(12.1%)(P<0.05).Conclusion:Preoperative limited resuscitation applied on patients with traumatic shock can reduce blood loss,incidence of ARDS and mor tality.

Advantages of nanocarriers for basic research in the field of traumatic brain injury

A major challenge for the efficient treatment of traumatic brain injury is the need for therapeutic molecules to cross the blood-brain barrier to enter and accumulate in brain tissue.To overcome this problem,researchers have begun to focus on nanocarriers and other brain-targeting drug delivery systems.In this review,we summarize the epidemiology,basic pathophysiology,current clinical treatment,the establishment of models,and the evaluation indicators that are commonly used for traumatic brain injury.We also report the current status of traumatic brain injury when treated with nanocarriers such as liposomes and vesicles.Nanocarriers can overcome a variety of key biological barriers,improve drug bioavailability,increase intracellular penetration and retention time,achieve drug enrichment,control drug release,and achieve brain-targeting drug delivery.However,the application of nanocarriers remains in the basic research stage and has yet to be fully translated to the clinic.

Music as medicine for traumatic brain injury:a perspective on future research directions

Traumatic brain injury(TBI) impacts 69 million individuals globally each year and is a leading cause of death and disability(Dewan et al.,2019).The majority of moderate-to-severe TBI survivors endure long-lasting disturbances in motor,cognitive,and affect that negatively impacts their life.Although a plethora of research on pharmacological interventions for TBI has been conducted,none has translated to the clinic,thus advocating for the evaluation of nonpharmacological therapeutic approaches that may increase translational success.

TDP-43 is a key molecule accelerating development of Alzheimer’s disease following traumatic brain injury

Currently,more than 55 million people have dementia worldwide and Alzheimer’s disease(AD)is one of the most common causes of dementia in aging.However,no effective therapies are currently available for the prevention and treatment of AD.This is largely due to our limited understanding of the mechanisms underlying the neuropathogenesis of AD.It has widely been recognized that AD is heterogeneous and that multi-factors are contributing to the pathogenesis of AD.Accumulated evidence suggests that traumatic brain injury(TBI)is an important risk factor for the development of AD and dementia later in life(Guo et al.,2000;Johnson et al.,2010).However,the precise mechanism by which TBI contributes to developing AD has yet to be elucidated.

Experimental and numerical study on protective effect of RC blast wall against air shock wave

Prototype experiments were carried out on the explosion-proof performance of the RC blast wall.The mass of TNT detonated in the experiments is 5 kg and 20 kg respectively.The shock wave overpressure was tested in different regions.The above experiments were numerically simulated,and the simulated shock wave overpressure waveforms were compared with that tested and given by CONWEP program.The results show that the numerically simulated waveform is slightly different from the test waveform,but similar to CONWEP waveform.Through dimensional analysis and numerical simulation under different working conditions,the equation for the attenuation rate of the diffraction overpressure behind the blast wall was obtained.According to the corresponding standards,the degree of casualties and the damage degree of the brick concrete building at a certain distance behind the wall can be determined when parameters are set.The above results can provide a reference for the design and construction of the reinforced concrete blast wall.

Evolution of molecular structure of TATB under shock loading from transient Raman spectroscopic technique

By combination of the transient Raman spectroscopic measurement and the density functional theoretical calculations,the structural evolution and stability of TATB under shock compression was investigated.Due to the improvement in synchronization control between two-stage light gas gun and the transient Raman spectra acquisition,as well as the sample preparation,the Raman peak of the N-O mode of TATB was firstly observed under shock pressure up to 13.6 GPa,noticeably higher than the upper limit of 8.5 GPa reported in available literatures.By taking into account of the continuous shift of the main peak and other observed Raman peaks,we did not distinguish any structural transition or any new species.Moreover,both the present Raman spectra and the time-resolved radiation of TATB during shock loading showed that TATB exhibits higher chemical stability than previous declaration.To reveal the detailed structural response and evolution of TATB under compression,the density functional theoretical calculations were conducted,and it was found that the pressure make N-O bond lengths shorter,nitro bond angles larger,and intermolecular and intra-molecular hydrogen bond interactions enhanced.The observed red shift of Raman peak was ascribed to the abnormal enhancement of H-bound effect on the scissor vibration mode of the nitro group.

Endorepellin downregulation promotes angiogenesis after experimental traumatic brain injury

Endorepellin plays a key role in the regulation of angiogenesis,but its effects on angiogenesis after traumatic brain injury are unclear.This study explored the effects of endorepellin on angiogenesis and neurobehavioral outcomes after traumatic brain injury in mice.Mice were randomly divided into four groups:sham,controlled cortical impact only,adeno-associated virus(AAV)-green fluorescent protein,and AAV-shEndorepellin-green fluorescent protein groups.In the controlled cortical impact model,the transduction of AAV-shEndorepellin-green fluorescent protein downregulated endorepellin while increasing the number of CD31+/Ki-67+proliferating endothelial cells and the functional microvessel density in mouse brain.These changes resulted in improved neurological function compared with controlled cortical impact mice.Western blotting revealed increased expression of vascular endothelial growth factor and angiopoietin-1 in mice treated with AAV-shEndorepellin-green fluorescent protein.Synchrotron radiation angiography showed that endorepellin downregulation promoted angiogenesis and increased cortical neovascularization,which may further improve neurobehavioral outcomes.Furthermore,an in vitro study showed that downregulation of endorepellin increased tube formation by human umbilical vein endothelial cells compared with a control.Mechanistic analysis found that endorepellin downregulation may mediate angiogenesis by activating vascular endothelial growth factor-and angiopoietin-1-related signaling pathways.

Propagation Properties of Shock Waves in Polyurethane Foam based on Atomistic Simulations

Porous materials are widely used in the field of protection because of their excellent energy absorption characteristics.In this work,a series of polyurethane microscopic models are established and the effect of porosity on the shock waves is studied with classical molecular dynamics simulations.Firstly,shock Hugoniot relations for different porosities are obtained,which compare well with the experimental data.The pores collapse and form local stress wave,which results in the complex multi-wave structure of the shock wave.The microstructure analysis shows that the local stress increases and the local velocity decreases gradually during the process of pore collapse to complete compaction.Finally,it leads to stress relaxation and velocity homogenization.The shock stress peaks can be fitted with two exponential functions,and the amplitude of attenuation coefficient decreases with the increase of density.Besides,the pore collapse under shock or non-shock are discussed by the entropy increase rate of the system.The energy is dissipated mainly through the multiple interactions of the waves under shock.The energy is dissipated mainly by the friction between atoms under non-shock.

Effect of the interval between two shocks on ejecta formation from the grooved aluminum surface

This work focuses on the effect of the interval between two shocks on the ejecta formation from the grooved aluminum(Al_(1100))surface by using smoothed particle hydrodynamics numerical simulation.Two unsupported shocks are obtained by the plate-impact between sample and two flyers at interval,with a peak pressure of approximately 30 GPa for each shock.When the shock interval varies from 2.11 to 7.67 times the groove depth,the bubble velocity reduces to a constant,and the micro jetting factor R_(J) from spike to bubble exhibits a non-monotonic change that decreases initially and then increases.At a shock interval of 3.6 times the groove depth,micro jetting factor R_(J) from spike to bubble reaches its minimum value of approximately 0.6.While,the micro jetting factor R_(F) from spike to free surface decreases linearly at first,and stabilizes around 0.25 once the shock interval surpasses 4.18 times the groove depth.When the shock interval is less than 4.18 times the groove depth,the unloading wave generated by the breakout of the first shock wave is superimpose with the unloading part of the second shock wave to form a large tensile area.

Neurotrophins and neural stem cells in posttraumatic brain injury repair

Traumatic brain injury(TBI)is the main cause of disability,mental health disorder,and even death,with its incidence and social costs rising steadily.Although different treatment strategies have been developed and tested to mitigate neurological decline,a definitive cure for these conditions remains elusive.Studies have revealed that vari-ous neurotrophins represented by the brain-derived neurotrophic factor are the key regulators of neuroinflammation,apoptosis,blood-brain barrier permeability,neurite regeneration,and memory function.These factors are instrumental in alleviating neu-roinflammation and promoting neuroregeneration.In addition,neural stem cells(NSC)contribute to nerve repair through inherent neuroprotective and immunomodulatory properties,the release of neurotrophins,the activation of endogenous NSCs,and in-tercellular signaling.Notably,innovative research proposals are emerging to combine BDNF and NSCs,enabling them to synergistically complement and promote each other in facilitating injury repair and improving neuron differentiation after TBI.In this review,we summarize the mechanism of neurotrophins in promoting neurogen-esis and restoring neural function after TBI,comprehensively explore the potential therapeutic effects of various neurotrophins in basic research on TBI,and investigate their interaction with NSCs.This endeavor aims to provide a valuable insight into the clinical treatment and transformation of neurotrophins in TBI,thereby promoting the progress of TBI therapeutics.

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.

Blood Calcium as a Protective Factor against Traumatic Fracture

Purpose: This study aims to investigate the predictive value of blood calcium in the prognosis of traumatic fracture. Methods: A retrospective experimental design was employed, 112 cases (52 non-fracture and 60 traumatic fracture) were randomly selected. The type of fracture complies with WHO-recommended (2019) diagnostic criteria for osteoporosis combined with fracture. The blood pressure (BP) was measured by OMRON’s HEM-7136 model electronic blood pressure monitor. Blood calcium (Ca2+), and blood phosphorus (P) values were measured using Colorimetric Roche kits on a Roche/Hitachi fully automated biochemical analyzer. Data collection and analysis followed. Results: Higher levels of age, systolic and diastolic blood pressures were found in the traumatic fracture group compared to the control group, whereas weight, height, and blood phosphorus did not differ significantly (P adjusting for age, systolic blood pressure, diastolic blood pressure, and blood phosphorus, binary logistic regression analysis revealed that blood calcium was a protective factor against traumatic fracture (β = -26.85, OR = 0.00, 95% CI = 0.00 -0.02, P = 0.022). Conclusion: The findings suggest that high and low blood calcium levels may serve as useful indicators in predicting the prognosis of fractures resulting from trauma.

Biomaterials and tissue engineering in traumatic brain injury:novel perspectives on promoting neural regeneration

Traumatic brain injury is a serious medical condition that can be attributed to falls, motor vehicle accidents, sports injuries and acts of violence, causing a series of neural injuries and neuropsychiatric symptoms. However, limited accessibility to the injury sites, complicated histological and anatomical structure, intricate cellular and extracellular milieu, lack of regenerative capacity in the native cells, vast variety of damage routes, and the insufficient time available for treatment have restricted the widespread application of several therapeutic methods in cases of central nervous system injury. Tissue engineering and regenerative medicine have emerged as innovative approaches in the field of nerve regeneration. By combining biomaterials, stem cells, and growth factors, these approaches have provided a platform for developing effective treatments for neural injuries, which can offer the potential to restore neural function, improve patient outcomes, and reduce the need for drugs and invasive surgical procedures. Biomaterials have shown advantages in promoting neural development, inhibiting glial scar formation, and providing a suitable biomimetic neural microenvironment, which makes their application promising in the field of neural regeneration. For instance, bioactive scaffolds loaded with stem cells can provide a biocompatible and biodegradable milieu. Furthermore, stem cells-derived exosomes combine the advantages of stem cells, avoid the risk of immune rejection, cooperate with biomaterials to enhance their biological functions, and exert stable functions, thereby inducing angiogenesis and neural regeneration in patients with traumatic brain injury and promoting the recovery of brain function. Unfortunately, biomaterials have shown positive effects in the laboratory, but when similar materials are used in clinical studies of human central nervous system regeneration, their efficacy is unsatisfactory. Here, we review the characteristics and properties of various bioactive materials, followed by the introduction of applications based on biochemistry and cell molecules, and discuss the emerging role of biomaterials in promoting neural regeneration. Further, we summarize the adaptive biomaterials infused with exosomes produced from stem cells and stem cells themselves for the treatment of traumatic brain injury. Finally, we present the main limitations of biomaterials for the treatment of traumatic brain injury and offer insights into their future potential.

Study of relationship between motion of mechanisms in gas operated weapon and its shock absorber

The article deals with the motion of the breech block carrier and the weapon casing of an automatic weapon mounted on a flexible carriage and the base of the weapon.Earlier works,which did not consider the dynamic properties of the base of the weapon,did not allow to reconcile the calculated and experimental results of the weapon casing displacement when shooting from firing rests.For the analysis of the motion of individual parts,the methods of mathematical modelling and firing experiments using a high-speed camera were chosen.Calculations show the best accord with experiment when modelling the system with 4 degrees of freedom.The oscillation of the system regarding the movement of the breech block carrier and the weapon casing was investigated under changed conditions of rate of fire,the use of a muzzle brake and different types of shock absorbers.The velocities and displacements of the weapon casing and the breech block carrier at different values of the impulse of the gases to the breech block carrier were determined.