From single to combinatorial therapies in spinal cord injuries for structural and functional restoration

Spinal cord injury results in paralysis, sensory disturbances, sphincter dysfunction, and multiple systemic secondary conditions, most arising from autonomic dysregulation. All this produces profound negative psychosocial implications for affected people, their families, and their communities;the financial costs can be challenging for their families and health institutions. Treatments aimed at restoring the spinal cord after spinal cord injury, which have been tested in animal models or clinical trials, generally seek to counteract one or more of the secondary mechanisms of injury to limit the extent of the initial damage. Most published works on structural/functional restoration in acute and chronic spinal cord injury stages use a single type of treatment: a drug or trophic factor, transplant of a cell type, and implantation of a biomaterial. Despite the significant benefits reported in animal models, when translating these successful therapeutic strategies to humans, the result in clinical trials has been considered of little relevance because the improvement, when present, is usually insufficient. Until now, most studies designed to promote neuroprotection or regeneration at different stages after spinal cord injury have used single treatments. Considering the occurrence of various secondary mechanisms of injury in the acute and sub-acute phases of spinal cord injury, it is reasonable to speculate that more than one therapeutic agent could be required to promote structural and functional restoration of the damaged spinal cord. Treatments that combine several therapeutic agents, targeting different mechanisms of injury, which, when used as a single therapy, have shown some benefits, allow us to assume that they will have synergistic beneficial effects. Thus, this narrative review article aims to summarize current trends in the use of strategies that combine therapeutic agents administered simultaneously or sequentially, seeking structural and functional restoration of the injured spinal cord.

Chinese expert consensus on the treatment of modern combat-related spinal injuries

The battlefield treatments of spinal and spinal cord injury vary from civilian settings. However, there is no unified battlefield treatment guidelines for spine trauma in PLA. An expert consensus is reached, based on spine trauma epidemiology and the concepts of battlefield treatment combined with the existing levels of military medical care in modern warfare. Since the specialized treatment for spine trauma are no significant difference between civilian settings and modern war, the first aid, emergency treatment and early treatment of spine trauma are introduced separately in three levels in this consensus. In Level I facilities, the fast and accurate evaluation of spine trauma followed by fixation and stabilization are recommended during the first-aid stage. Re-evaluation, further treatment for possible hemorrhagic shock, dyspnea and infection are recommended at Level II facilities. At Level III facilities, it is recommended to strengthen the intensive care and the prevention of urinary system and lung infection for the wounded with severe spinal injury, however, spinal surgery is not recommended in a battlefield hospital. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.

Promoting axonal regeneration following nerve surgery： a perspective on ultrasound treatment for nerve injuries

Nerve injury is often associated with limited axonal regeneration and thus leads to delayed or incomplete axonal reinnervation.As a consequence of slow nerve regeneration,target muscle function is often insufficient and leads to a lifelong burden.Recently,the diagnosis of nerve injuries has been improved and likewise surgical reconstruction has undergone significant developments.However,the problem of slow nerve regeneration has not been solved.In a recent meta-analysis,we have shown that the application of low-intensity ultrasound promotes nerve regeneration experimentally and thereby can improve functional outcomes.Here we want to demonstrate the experimental effect of low intensity ultrasound on nerve regeneration,the current state of investigations and its possible future clinical applications.

Diagnosis and Treatment of 42 Cases of Multiple Injuries with Pancreatic Injury

In order to summarize the clinical diagnosis and treatment methods for 42 cases of multiple injuries with pancreatic injury, a retrospective analysis on 42 cases of multiple injuries with pancreatic injury from January 1990 to January 2006 was carried out in our hospital. Most cases were associated with hemopneumothorax and rib fractures （52.3%）, shock （50%）, multiple fractures （47.6%）, and severe brain injury （26.1%）. In 42 cases, one case died of severe hemorrhagic shock, and the remaining 41 cases （97.6%） were cured （including 40 cases receiving surgical operation and one case receiving the conservative treatment）. Postoperative complications occurred in 16 cases （21 cases/times）： pancreatic fistula （5 cases/times） and incisional wound infection （5 cases/times）, intra-abdominal infection （3 cases/times）, stress ulcer （3 cases/times）, pleural effusion （3 cases/times）, pulmonary infection （one case） and wound dehiscence （1 case）. The principle therapy of multiple injuries with pancreatic injury is to rescue life, followed by active treatment to prevent injuries which giving rise to the abnormal respiratory and circulatory functions, management of cerebral hernia and other injuries which endangers life at last, and the pancreatic injury to increase the survival rate and survival quality.

Relief of Residual Stresses in 800 MPa Grade High Strength Steel Weldments by Explosion Treatment and its Effect on Mechanical Properties

The explosion treatment technique has been used in the relief of residual stresses in 800 MPa grade high strength steel manual welded joints. The residual stresses on surface and through thickness of the weldment were measured for both as-welded and explosion-treated sample, the mechanical properties of welded joints under different conditions were also tested. The effect of explosion treatment on the fracture toughness of materials with a residual defect was investigated by crack opening displacement （COD） test. The results show that explosion treatment can reduce not only the surface residual stress but also the residual stress through thickness in the welded joints. The effect of explosion treatment on the mechanical properties and a residual defect in welded joint were inconspicuous.

Emergency Treatment and Nursing Care of a Patient with Multiple Injuries and Right Main Bronchus Rupture

Objective: To investigate the rescue and nursing process of a trauma patient with multiple injuries and rupture of the right main bronchus. Methods: A patient with multiple injuries and rupture of the right main bronchus admitted to the emergency department of the Shenzhen Hospital of the University of Hong Kong was selected as the research object on December 11, 2019. Results: In this case, the medical team treated the patient under the guidance of ATLS (Advanced Traumatic Life Support), and for the first time in our department, we used bronchoscopy to replace the double-lumen endotracheal tube for left lung single-lung ventilation, finally the patient was successfully treated. Conclusion: Through a literature search, it is found that the main bronchus rupture is less common in clinical practice. In the trauma group, the use of fiberoptic bronchoscopy and the replacement of a double-lumen tracheal tube for left lung single-lung ventilation can improve the treatment rate of such patients and is worthy of clinical application.

Application of Explosion Method to Soft Foundation Treatment of Great-West Dyke,Lianyungang Port

Explosion for the treatment of underwater soft foundation is a technique newly developed in China. This paper describes the application of the method of explosion to underwater soft foundation treatment of the Great-West Dyke, Lianyungang Port, including the technical characteristics and the effect, selection of explosion parameters, workmanship of construction, requirements of quality and inspection, and the like.

Study of relieving weld residual stresses in large pressure steel pipes of hydropower station by local explosion treatment

From comparing the test of local explosion treatment(LET)with the locaf heat treatment (LHT)in welded plates and welded steel pipes in field,LET has excellent effect of stress relief and high efficiency. Whereas the effect of stress relief for LHT with 575℃×1.5hr is poor.The mechanical properties of welded joints after LET are basically the same as those of as-welded joints.The practically measuring results on 4 large steel-pipe surfaces indicate that the welding residual tensile stresses in welds,which mostly is compression residual stress,are basically relieved.

Clinical diagnosis and surgical treatment of pancreatic and/or duodenal injuries

Objective: To investigate the points of the clinical diagnosis and surgical treatment for pancreatic and/or duodenal injuries. Methods: Clinical data of 30 patients who suffered from pancreatic and/or duodenal injuries were reviewed. Results: There were 29 cases who received surgical management. Of the 30 cases, 22 cases were cured, seven cases died, and postoperative complications occurred in 16 cases. The cure rate was 73.3%. Conclusion: Pancreatic and/or duodenal injuries are severe abdominal injuries and difficult to treat. The mortality and complication rate are high. The keys to successful treatments for pancreatic and/or duodenal injuries are early diagnosis, careful exploration and proper operational management.

Secondary injuries caused by ill-suited rehabilitation treatments: Five case reports

BACKGROUND Increasing attention is being given to burn rehabilitation,and an increasing number of burn patients are undergoing rehabilitation.However,little attention has been given to secondary injuries caused by ill-suited rehabilitation practices.Patients,especially those in undeveloped countries,sustain injuries due to inadequate burn rehabilitation practices and the nonstandard implementation of rehabilitation treatments.CASE SUMMARY This study reports 5 cases of secondary injuries caused by ill-suited burn rehabilitation practices in our institute,including first web space contracture caused by a single orthosis treatment,finger deformity caused by improper compression therapy with a self-adhering bandage,developmental impairment of the affected limb caused by continuous improper compression therapy,and fracture caused by overly intensive rehabilitation exercise.CONCLUSION More attention should be given to burn rehabilitation to reduce the incidence of secondary injuries caused by ill-suited rehabilitation practices.Burn rehabilitation system should include specialized hospitals(burn rehabilitation centers),community hospitals,and family rehabilitation clinics.Precise instruments and equipment,accurate measurement methods,objective monitoring indicators and standardized guidelines and recommendations will help improve the quality of burn rehabilitation.Additionally,more attention should be given to burn rehabilitation in children.

Experimental study on gas explosion to kill and injury mouse

The killing and injury effects of gas explosion shock wave on mouse in an open space pipeline is tested experimentally. When the methane volume fraction is 10M, the maximum explosion pressure is 0. 264 MPa and the injury is the most serious. Specially, some designed obstacles put in the open space pipeline are conducive to producing more stronger gas explosion shock wave. Accordingly, the injury effect of methane explosion on mouse is enhanced under obstacles condition. When the methane volume fraction is 10%, the maximum explosion pressure can reach 0. 298 MPa under obstacles conditiorL It can be concluded that to reduce explosive accident impact, the obstacles in coal mine should be avoided. With the explosions increasing, the death pressure of mouse decreases.

Multiligament knee injuries with associated tibial plateau fractures: A report of two cases

The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI's in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI's with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.

Effects of heat treatment on the intermetallic compounds and mechanical properties of the stainless steel 321–aluminum 1230 explosive-welding interface

The effects of heat treatment on the microstructure and mechanical properties of intermetallic compounds in the interface of stainless steel 321 explosively bonded to aluminum 1230 were investigated in this study. Experimental investigations were performed by optical microscopy, scanning electron microscopy, and microhardness and shear tensile strength testing. Prior to heat treatment, increasing the stand-off distance between samples from 1 to 2.5 mm caused their interface to become wavy and the thickness of intermetallic layers to increase from 3.5 to 102.3 μm. The microhardness increased from HV 766 in the sample prepared at a stand-off distance of 1 mm to HV 927 in the sample prepared at a stand-off distance of 2.5 mm; in addition, the sample strength increased from 103.2 to 214.5 MPa. Heat treatment at 450°C for 6 h increased the thickness of intermetallic compound layers to 4.4 and 118.5 μm in the samples prepared at stand-off distances of 1 and 2.5 mm, respectively. These results indicated that increasing the duration and temperature of heat treatment decreased the microhardness and strength of the interface of explosively welded stainless steel 321-Al 1230 and increased the thickness of the intermetallic region.

Incidence, casualties and risk characteristics of civilian explosion blast injury in China: 2000-2017 data from the State Administration of Work Safety

Background: Civilian explosion blast injury is more frequent in developing countries, including China. However, the incidence, casualties, and characteristics of such incidents in China are unknown.Methods: This is a retrospective analysis of the State Administration of Work Safety database. Incidents during a period from January 1, 2000 to April 30, 2017 were included in the analysis. The explosions were classified based on the number of deaths into extraordinarily major, major, serious and ordinary type. Descriptive statistics was used to analyze the incidence and characteristics of the explosions. Correlation analysis was performed to examine the potential correlations among various variables.Results: Data base search identified a total of 2098 explosions from 2000 to 2017, with 29,579 casualties: 15,788 deaths(53.4%), 12,637 injured(42.7%) and 1154 missing(3.9%). Majority of the explosions were serious type(65.4%). The number of deaths(39.5%) was also highest with the serious type(P=0.006). The highest incidence was observed in the fourth quarter of the year(October to December), and at 9:00–11:00 am and 4:00–6:00 pm of the day. The explosions were most frequent in coal-producing provinces(Guizhou and Shanxi Province). Coal mine gas explosions resulted majority of the deaths(9620, 60.9%). The number of explosion accidents closely correlated with economic output(regional economy and national GDP growth rate)(r=–0.372, P=0.040;r=0.629, P=0.028).Conclusions: The incidence and civilian casualties due to explosions remain unacceptable in developing China. Measures that mitigate the risk factors are of urgently required.

Effect of postweld heat treatment on interface microstructure and metallurgical properties of explosively welded bronze–carbon steel

The effects of postweld heat treatment on the microstructure and metallurgical properties of a bronze–carbon steel(st37)explosively bonded interface were studied.Explosive welding was done under 1.5-and 2-mm standoff distances and different conditions of explosive charge.Samples were postweld heat treated for 4 and 16 h in the furnace at 250°C and 500°C and then air cooled.Laboratory studies using optical microscopy,scanning electron microscopy,and microhardness testing were used to evaluate the welded samples.Microstructural examinations showed that by increasing the standoff distance and the explosive charge,the interface of bronze to steel became wavier.The microhardness test result showed that the hardness of the samples was higher near the joint interface compared with other areas because of the intensive plastic deformation,which was caused by the explosion force.The results show that increasing the heat treatment temperature and time caused the intermetallic compounds’layer thickness to increase,and,because of the higher diffusion of copper and tin,the iron amount in the intermetallic compounds decreased.Also,because of the increase in heat treatment temperature and time,internal stresses were released,and the interface hardness decreased.

Influence of Vapor Cloud Shape on Temperature Field of Unconfined Vapor Cloud Explosion

In order to analyze the influence of vapor cloud shape on temperature field effect of unconfined vapor cloud explosion(UVCE)and obtain creditable prediction method of explosion temperature effect,the transient temperature fields of cylindrical and hemispherical UVCEs with same methane concentration and mass were numerically studied by computational fluid dynamics(CFD)technology.According to numerical simulation results, the concepts of UVCE’s temperature-near-field and temperature-far-field were proposed,the corresponding ranges were given,and the temperature attenuation laws and differences in corresponding regions with different vapor cloud shapes were presented.Through comparing with Baker fireball model,the accuracy and visualizability in acquisition of entire temperature effect based on numerical simulation were further validated.The functional relations among maximum temperature,horizontal distance,initial temperature and vapor cloud mass in temperature-near-field and temperature-far-field were deduced by means of data fitting,respectively.These conclusions provided quantitative basis for forecast and protection of UVCE disaster.

Isolated segmental,sectoral and right hepatic bile duct injuries

The treatment of isolated segmental, sectoral and right hepatic bile duct injuries is controversial. Nineteen patients were treated over a 26-year period. Group one was comprised of 4 patients in whom the injury was primarily repaired during the original surgery; 3 over a T-tube, 1 with a Roux-en-Y. These patients had an uneventful recovery. The second group consisted of 5 patients in whom the duct was ligated; 4 developed infection, 3 of which required drainage and biliary repair. Two patients had good long-term outcomes; the third developed a late anastomotic stricture requiring further surgery. The fourth patient developed a small bile leak and pain which resolved spontaneously. The fifth patient developed complications from which he died. The third group was comprised of 4 patients referred with biliary peritonitis; all underwent drainage and lavage, and developed biliary fistulae, 3 of which resolved spontaneously, 1 required Roux-en-γ repair, with favorable outcomes. The fourth group consisted of 6 patients with biliary fistulae. Two patients, both with an 8-wk history of a fistula, underwent Roux-en-γ repair. Two others also underwent a Roux-en-γ repair, as their fistulae showed no signs of closure. The remaining 2 patients had spontaneous closure of their biliary fistulae. A primary repair is a reasonable alternative to ligature of injured duct. Patients with ligated ducts may develop complications. Infected ducts require further surgery. Patients with biliary peritonitis must be treated with drainage and lavage. There is a 50% chance that a biliary fistula will close spontaneously. In cases where the biliary fistula does not close within 6 to 8 wk, a Roux-en-γ anastomosis should be considered.

Is laparoscopy equal to laparotomy in detecting and treating small bowel injuries in a porcine model?

AIM: To evaluate the safety and effectiveness of laparoscopy compared with laparotomy for diagnosing and treating small bowel injuries (SBIs) in a porcine model. METHODS: Twenty-eight female pigs were anesthetized and laid in the left recumbent position. The SBI model was established by shooting at the right lower quadrant of the abdomen. The pigs were then randomized into either the laparotomy group or the laparoscopy group. All pigs underwent routine exploratory laparotomy or laparoscopy to evaluate the abdominal injuries, particularly the types, sites, and numbers of SBIs. Traditional open surgery or therapeutic laparoscopy was then performed. All pigs were kept alive within the observational period (postoperative 72 h). The postoperative recovery of each pig was carefully observed. RESULTS: The vital signs of all pigs were stable within 1-2 h after shooting and none of the pigs died from gunshot wounds or SBIs immediately. The SBI model was successfully established in all pigs and definitively diagnosed with single or multiple SBIs either by exploratory laparotomy or laparoscopy. Compared with exploratory laparotomy, laparoscopy took a significantly longer time for diagnosis (41.27 ± 12.04 min vs 27.64 ± 13.32 min, P = 0.02), but the time for therapeutic laparoscopy was similar to that of open surgery. The length of incision was significantly reduced in the laparoscopy group compared with the laparotomy group (5.27 ± 1.86 cm vs 15.73 ± 1.06 cm, P < 0.01). In the final post-mortem examination 72 h after surgery, both laparotomy and laparoscopy offered a definitive diagnosis with no missed injuries. Postoperative complications occurred in four cases (three following laparotomy and one following laparoscopy, P = 0.326). The average recovery period for bowel function, vital appearance, and food re-intake after laparoscopy was 10.36 ± 4.72 h, 14.91 ± 3.14 h, and 15.00 ± 7.11 h, respectively. All of these were significantly shorter than after laparotomy (21.27 ± 10.17 h, P = 0.004; 27.82 ± 9.61 h, P < 0.001; and 24.55 ± 9.72 h, respectively, P = 0.016). CONCLUSION: Compared with laparotomy, laparoscopy offers equivalent efficacy for diagnosing and treating SBIs, and reduces postoperative complications as well as recovery period.

Numerical simulation for explosion wave propagation of combustible mixture gas

A two-dimensional multi-material code was indigenously developed to investigate the effects of duct boundary conditions and ignition positions on the propagation law of explosion wave for hydrogen and methane-based combustible mixture gas. In the code,Young's technique was employed to track the interface between the explosion products and air,and combustible function model was adopted to simulate ignition process. The code was employed to study explosion flow field inside and outside the duct and to obtain peak pressures in different boundary conditions and ignition positions. Numerical results suggest that during the propagation in a duct,for point initiation,the curvature of spherical wave front gradually decreases and evolves into plane wave. Due to the multiple reflections on the duct wall,multi-peak values appear on pressure-time curve,and peak pressure strongly relies on the duct boundary conditions and ignition position. When explosive wave reaches the exit of the duct,explosion products expand outward and forms shock wave in air. Multiple rarefaction waves also occur and propagate upstream along the duct to decrease the pressure in the duct. The results are in agreement with one-dimensional isentropic gas flow theory of the explosion products,and indicate that the ignition model and multi-material interface treatment method are feasible.

Novel method of primary endoscopic realignment for high-grade posterior urethral injuries:A case report

BACKGROUND A male urethral disruption injury is a urological emergency.Primary endoscopic realignment(PER)refers to reestablishment of urethral alignment via indwelling urethral catheter by cystoscope,which is recommended as the optimal emergent treatment approach for reducing the likelihood of complications following injury.However,the prior literature suggests the success rate of PER to be relatively low due to complicated urethral disruption.We report a modified PER approach that serves to improve both the success rate and safety of the treatment.CASE SUMMARY A 19-year-old male patient presented with multiple pelvic fractures and complete urethral disruption following a high-velocity traffic accident.The patient’s abdominal computed tomography and retrograde urethrography results revealed complete urethral disruption at the bulbar urethra,with hematoma and contrast medium extravasation that extended into the extraperitoneal space.The conventional retrograde PER by cystoscope failed due to severe disruption and considerable hematoma.Modified simultaneous antegrade and retrograde PER was performed by means of semi-rigid ureteroscopy via a suprapubic Foley catheter and cystoscopy via the external urethra.An antegrade guidewire was passed through the bladder neck and then pulled out through the external urethral meatus with a cystoscope.Urethral continuity was achieved after a 16-Fr silicone Foley catheter was indwelled into the bladder along the guidewire.The patient recovered well,achieving voiding continence and avoiding further operation for urethral stricture.CONCLUSION Modified PER via suprapubic Foley catheter represents a promising and safe treatment approach in patients with posterior urethral injuries.