Comprehensive rehabilitation of closed injury of brain

Objective To observe the effect of physical factors and promotion canalization on c losed injury of brain.Method68cases of closed injury of brain were given the comprehensive rehabilitation therapy with many physical factors and promoting canalization technique.Result The patients’ consciousnesses were significantly improved after treatment.The moto rial function of hemiplegic limbs wa s distinctly improved(P <0.05).The balance functions were distinctly improved(P <0.001).The activities of daily living abilities were significantly improved(P <0.05).Conclusion The physical factors and promoting c analization treatment on the closed injury of brain are functionally eff ective.

Long non-coding RNA H19 regulates neurogenesis of induced neural stem cells in a mouse model of closed head injury

Stem cell-based therapies have been proposed as a potential treatment for neural regeneration following closed head injury.We previously reported that induced neural stem cells exert beneficial effects on neural regeneration via cell replacement.However,the neural regeneration efficiency of induced neural stem cells remains limited.In this study,we explored differentially expressed genes and long non-coding RNAs to clarify the mechanism underlying the neurogenesis of induced neural stem cells.We found that H19 was the most downregulated neurogenesis-associated lnc RNA in induced neural stem cells compared with induced pluripotent stem cells.Additionally,we demonstrated that H19 levels in induced neural stem cells were markedly lower than those in induced pluripotent stem cells and were substantially higher than those in induced neural stem cell-derived neurons.We predicted the target genes of H19 and discovered that H19 directly interacts with mi R-325-3p,which directly interacts with Ctbp2 in induced pluripotent stem cells and induced neural stem cells.Silencing H19 or Ctbp2 impaired induced neural stem cell proliferation,and mi R-325-3p suppression restored the effect of H19 inhibition but not the effect of Ctbp2 inhibition.Furthermore,H19 silencing substantially promoted the neural differentiation of induced neural stem cells and did not induce apoptosis of induced neural stem cells.Notably,silencing H19 in induced neural stem cell grafts markedly accelerated the neurological recovery of closed head injury mice.Our results reveal that H19 regulates the neurogenesis of induced neural stem cells.H19 inhibition may promote the neural differentiation of induced neural stem cells,which is closely associated with neurological recovery following closed head injury.

Induced neural stem cells regulate microglial activation through Akt-mediated upregulation of CXCR4 and Crry in a mouse model of closed head injury

Microglial activation that occurs rapidly after closed head injury may play important and complex roles in neuroinflammation-associated neuronal damage and repair.We previously reported that induced neural stem cells can modulate the behavior of activated microglia via CXCL12/CXCR4 signaling,influencing their activation such that they can promote neurological recovery.However,the mechanism of CXCR4 upregulation in induced neural stem cells remains unclear.In this study,we found that nuclear factor-κB activation induced by closed head injury mouse serum in microglia promoted CXCL12 and tumor necrosis factor-αexpression but suppressed insulin-like growth factor-1 expression.However,recombinant complement receptor 2-conjugated Crry(CR2-Crry)reduced the effects of closed head injury mouse serum-induced nuclear factor-κB activation in microglia and the levels of activated microglia,CXCL12,and tumor necrosis factor-α.Additionally,we observed that,in response to stimulation(including stimulation by CXCL12 secreted by activated microglia),CXCR4 and Crry levels can be upregulated in induced neural stem cells via the interplay among CXCL12/CXCR4,Crry,and Akt signaling to modulate microglial activation.In agreement with these in vitro experimental results,we found that Akt activation enhanced the immunoregulatory effects of induced neural stem cell grafts on microglial activation,leading to the promotion of neurological recovery via insulin-like growth factor-1 secretion and the neuroprotective effects of induced neural stem cell grafts through CXCR4 and Crry upregulation in the injured cortices of closed head injury mice.Notably,these beneficial effects of Akt activation in induced neural stem cells were positively correlated with the therapeutic effects of induced neural stem cells on neuronal injury,cerebral edema,and neurological disorders post–closed head injury.In conclusion,our findings reveal that Akt activation may enhance the immunoregulatory effects of induced neural stem cells on microglial activation via upregulation of CXCR4 and Crry,thereby promoting induced neural stem cell–mediated improvement of neuronal injury,cerebral edema,and neurological disorders following closed head injury.

Distinct proteins in cortex of rats with closed traumatic brain injury detected by a WCX-2 protein chip

BACKGROUND： Mechanical injury can cause the changes of polygene expression spectrum in rat cerebral cortical nerve cells, and then result in the changes of intracellular protein expression. At present, dielectrophoresis is combined with mass spectrum technique to detect the expression of different proteins in rat cortex after brain injury, but the protein chip technique requires further investigation. OBJECTIVE： To analyze the differences of protein expression spectrum in rat cerebral cortex before and after closed traumatic brain injury using WCX-2 protein chip technique. DESIGN： A randomized controlled animal experiment. SETTING： Training Division of the Medical College of Chinese People＇s Armed Police Force. MATERIALS： Seventy-two male SD rats of clean degree, 350 - 450 g, were provided by the Experimental Animal Center, Academy of Military Medical Sciences of Chinese PLA. Urea, trifluoroacetic acid, CHAPS and Tris （Sigma, USA）; WCX-2 （Ciphergen, USA）. Ultra-high speed hypothermia centrifuger （Bechman, USA）; Rotary tissue microtome （Keuca, Germany）; Biochip processor and PBS II-C protein chip reader （Ciphergen, USA）. METHODS： The experiments were carried out in the Institute of Molecular Pathology, Central Laboratory, and Department of Pathology, Medical College of Chinese People＇s Armed Police Force from June 2005 to March 2006. ① Grouping and treatment： The experiments were completed in molecular pathological institute, central laboratory and pathological department. ② The rats were randomly divided into control group （n =12） and brain injury group （n =60）. Marmarou＇s weight-dropping models were duplicated at different time points in the brain injury group. In the control group, the rats were only treated by incising the skin of head top, without fixing the stainless steel hitting backup plate at the vault of skull, and obtain brain cortex for pathological and protein chip research, and they were killed after 24 hours. The rats in the brain injury group were killed at 4, 8, 12, 24 and 48 hours after model establishment. ③ Pathological observation： Longitudinal section was made on cerebral cortex, and sections of 5 μm were prepared, then stained with hematoxylin and eosin （HE）. ④Protein chip analysis： 100 mg cerebral cortex was collected from each rat, and the protein content in sample was detected with Bradford method, meanwhile, WCX-2 protein chip was used to analyze the protein spectrum. The data were automatically collected with Ciphergen proteinchip 3.0 software, and the results were analyzed using Biomarker Wizard software to compare the differences of protein spectrum in rat cortex between the groups. MAIN OUTCOME MEASURES： Results of the pathological observation of cerebral cortex and the protein spectrum analysis. RESULTS：①Pathological changes of cerebral cortex： In the control group, no necrosis and edema was observed. In the brain injury group, injures of different severity occurred at different time points; After 4 hours, focal or scattered red nerve cells could be observed, the size of some cells was increased, cytoplasm was lightly stained, and only nuclear fragments were seen; After 8 hours, the necrotic nerve cells were increased, and the number of nerve cells was reduced, astrocytes （neuronophagia） could be seen in partial cytoplasm; there was small vascular dilatation, and endothelial cell proliferation; interstitial edema, regional rarefaction lightly stained. After 12- 48 hours, the necrotic nerve cells were reduced, and astrocytes proliferated. ② Results of protein spectrum analysis： The WCX-2 experiment found that the expressions of 5 639, 3 212 and 7 536 u proteins in cerebral cortex changed after injury in the brain injury group. The peak intensity of 5 639 u protein in the brain injury group at 8 hours after injury was higher than that in the control group （P 〈 0.05）; The peak intensity of 3 212 u protein in the brain injury group at 48 hours after injury was higher than that in the control group （P 〈 0.05）; The peak intensity of 7 536 u protein at 24 hours after injury was higher than that in the control group （P 〈 0.05）. CONCLUSION： Brain injury can cause the changes of protein expression spectrum in cerebral cortex, it is suggested that brain injury can induce the expression of protein.

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.

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.

Changes in neurological and pathological outcomes in a modified rat spinal cord injury model with closed canal

Most animal spinal cord injury models involve a laminectomy,such as the weight drop model or the transection model.However,in clinical practice,many patients undergo spinal cord injury while maintaining a relatively complete spinal canal.Thus,open spinal cord injury models often do not simulate real injuries,and few previous studies have investigated whether having a closed spinal canal after a primary spinal cord injury may influence secondary processes.Therefore,we aimed to assess the differences in neurological dysfunction and pathological changes between rat spinal cord injury models with closed and open spinal canals.Sprague-Dawley rats were randomly divided into three groups.In the sham group,the tunnel was expanded only,without inserting a screw into the spinal canal.In the spinal cord injury with open canal group,a screw was inserted into the spinal canal to cause spinal cord injury for 5 minutes,and then the screw was pulled out,leaving a hole in the vertebral plate.In the spinal cord injury with closed canal group,after inserting a screw into the spinal canal for 5 minutes,the screw was pulled out by approximately 1.5 mm and the flat end of the screw remained in the hole in the vertebral plate so that the spinal canal remained closed;this group was the modified model,which used a screw both to compress the spinal cord and to seal the spinal canal.At 7 days post-operation,the Basso-Beattie-Bresnahan scale was used to measure changes in neurological outcomes.Hematoxylin-eosin staining was used to assess histopathology.To evaluate the degree of local secondary hypoxia,immunohistochemical staining and western blot assays were applied to detect the expression of hypoxia-inducible factor 1α(HIF-1α)and vascular endothelial growth factor(VEGF).Compared with the spinal cord injury with open canal group,in the closed canal group the Basso-Beattie-Bresnahan scores were lower,cell morphology was more irregular,the percentage of morphologically normal neurons was lower,the percentages of HIF-1α-and VEGF-immunoreactive cells were higher,and HIF-1αand VEGF protein expression was also higher.In conclusion,we successfully established a rat spinal cord injury model with closed canal.This model could result in more serious neurological dysfunction and histopathological changes than in open canal models.All experimental procedures were approved by the Institutional Animal Care Committee of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,China(approval No.HKDL201810)on January 30,2018.

Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury

AIM: To elucidate the question of whether the ocular trauma score(OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment(RD) in patients with open globe injury(OGI).METHODS: A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS: Totally 102 patients with traumatic OGI with a minimum of 12 mo follow-up and a median age at of 48.6 y(range: 3-104 y) were identified. Final best corrected visual acuity(BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score Ⅰ(P<0.0001) or Ⅱ(P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >Ⅲ. OGI associated RD was observed in 36/102 patients(35.3%), whereas post traumatic RD(defined as RD following 14 d after OGI) occurred in 37 patients(36.3%). OGI associated RD did not correlate with the OTS and the zone of injury(P=0.193), yet post traumatic RD correlated significantly with zone Ⅲ injuries(P=0.013). CONCLUSION: The study shows a significant association between lower OTS score and zone Ⅲ injury with lower final BCVA and a higher number of surgeries, but only zone Ⅲ could be significantly associated with a higher rate of RD.

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.

COMPARATIVE OBSERVATION ON CURATIVE EFFECT OF POSTOPERATIVE SYMPTOMS OF THE CLOSED CRANIOCEREBRAL INJURY TREATED BY ACUPUNCTURE

The results of treating the closed injury of brain with two methods are reported, one is Western medicine treatment (control group), and the other is acupuncture combined with Western medicine treatment (acupuncture group). The total curative rate of the latter is 86 %, and that of the former is 56 %. The therapeutic effect of acupuncture group is better than that of control group. Coordinating acupuncture therapy in early stage is thus certainly necessary. At the same time, pathogenesis of the disease and the mechanism of acupuncture treatment are also discussed.

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

Clinical study on the surgical treatment of atypical Lisfranc joint complex injury

BACKGROUND Lisfranc injuries have not received much attention by orthopedic doctors in the past,and there is little related research on the diagnosis and treatment of these injuries.In recent years with the rise in foot and ankle surgery,doctors are now paying more attention to this type of injury.However,there is still a high rate of missed diagnosis due to insufficient attention causing treatment delays or inadequate treatments,which eventually result in greater sequelae;including long-term pain,arthritis,foot deformity etc.In particular,for cases with a mild Lisfranc joint complex injury,the incidence of sequelae is higher.AIM To select an active surgical treatment for an atypical Lisfranc joint complex injury and to evaluate the clinical efficacy of the surgical treatment.METHODS The clinical data of 18 patients,including 10 males and 8 females aged 20-64 years with Lisfranc injuries treated in our department from January 2017 to September 2019 were retrospectively analyzed.All patients were treated with an open reduction and internal fixation method using locking titanium mini-plates and hollow screws or Kirschner wires.X-ray images were taken and follow-up was performed monthly after the operation;the internal fixation was then removed 4-5 mo after the operation;and the American Orthopedic Foot and Ankle Society(AOFAS)score was used for evaluation on the last follow-up.RESULTS All patients were followed up for 6-12 mo.A good/excellent AOFAS score was observed in 88.9%of patients.CONCLUSION For atypical Lisfranc joint complex injuries,active open reduction and internal fixation can be performed to enable patients to obtain a good prognosis and satisfactory functional recovery.

Tendo-Achilles injury:An observational study in a tertiary care hospital

Objective:To report demographic and injury characteristics of tendo-Achilles(TA)injury,and determine its association with the use of Indian style commode seat(ISCS),the clinical and functional outcomes.Methods:This observational study was conducted between 1 January 2016 and 31 December 2019,and a total of 44 patients with TA injury were included in the study.Their demographic profile,etiology,operative details,and functional outcomes were studied.All patients underwent primary repair followed by standard postoperative management and follow-up for 6 months.Results:Out of 44 patients,7(15.9%)sustained closed injuries while 37(84.1%)sustained open injuries.In open injury cases,30(81%)patients suffered an injury due to slipping in ISCS,4(11%)from road traffic accidents,and 3(8%)due to falling of a heavy object.Besides,20.45%of cases of ISCS injury had associated neurovascular injury.Twenty(45%)patients took more than 90 days to start independent ambulation.At 6 months follow-up,no one could reach pre-injury fitness status.Conclusions:Open TA injury by ISCS is an important,under-reported,and preventable cause of loss of physically active manpower in institutional setups.

开放性眼外伤玻璃体切割手术预后及影响因素

目的探讨开放性眼外伤行玻璃体切割手术(PPV)治疗的预后情况,并对其相关影响因素进行分析。方法回顾性研究2013-01至2022-12在武警四川总队医院、乐山市眼科中心、成都中医药大学附属眼科医院行PPV治疗的开放性眼外伤患者241例(241眼)的临床资料。记录术前临床特征,包括性别、年龄、外伤类型、外伤分区、眼内异物、视力、眼压、相对性传入性瞳孔障碍、受伤至PPV时间(受伤~手术时间)、感染性眼内炎和组织受累情况。根据患者情况制定相应的PPV方案,术后随访6个月,每次随访记录视力、眼压、屈光介质情况,视网膜复位情况,眼球保留和摘除情况。根据末次随访结果评判手术预后情况。采用多因素回归分析术前临床特征与手术预后的相关性。结果241眼中,解剖痊愈113眼(46.9%),功能痊愈93眼(38.6%),总治愈206眼(85.5%),未愈35眼(14.5%),眼球摘除17眼(7.1%)。多因素回归分析显示总治愈率与外伤类型、外伤分区、受伤~手术时间相关,眼球摘除率与外伤类型、术前视力、受伤~手术时间相关。结论PPV治疗开放性眼外伤疗效显著,外伤类型、外伤分区、术前视力和受伤~手术时间是影响手术预后的相关因素。

重复经颅磁刺激外周-中枢闭环治疗模式治疗脊髓损伤后神经源性膀胱的研究

目的:研究重复经颅磁刺激外周-中枢闭环治疗模式对脊髓损伤后神经源性膀胱治疗的影响。方法:选取2020年5月—2022年2月茂名市人民医院收治的脊髓损伤后神经源性膀胱患者80例作为研究对象,采用随机数字表法将患者分为A组、B组,各40例,均进行常规康复治疗,A组加用低频电刺激治疗,B组加用重复经颅磁刺激外周-中枢闭环治疗模式。对比两组治疗前后尿流动力学、膀胱容量与压力、生活质量。结果:治疗4周后,两组残余尿量较治疗前均降低,最大尿流率、最大膀胱容量均较治疗前升高,膀胱内压力较治疗前均降低,且B组均优于A组(P<0.05);两组每天单次排尿量较治疗前均提高,排尿次数均较治疗前降低,且B组均优于A组(P<0.05);两组泌尿症状困扰评分量表(USDS)、国际下尿路症状(LUTS)评分均较治疗前降低,且B组均较A组低(P<0.05)。治疗4周后,两组世界卫生组织生存质量测定简表(WHOQOL-BREF)中生理、心理、社会关系、生活环境评分均较治疗前提高,且B组均较A组高,差异均有统计学意义(P<0.05)。结论:重复经颅磁刺激外周-中枢闭环治疗模式对脊髓损伤后神经源性膀胱治疗后的尿流动力学具有改善作用,且可以增加膀胱容量,改善排尿尿量及次数,改善生活质量。

郑氏手法整复结合夹板中立板外固定治疗儿童桡骨远端骨骺骨折

目的:探讨郑氏手法整复结合夹板中立板外固定治疗儿童桡骨远端骨骺骨折的手法操作及其临床疗效。方法:2022年3月~2023年9月收治的桡骨远端骨骺骨折患儿46例,采取郑氏手法整复结合夹板中立板外固定治疗。复位前、复位后即刻、复位后6月测量腕关节桡骨高度、桡骨掌倾角、桡骨尺偏角,采用Gartland-Welley评估量表评价腕关节功能,记录患者压疮、张力性水泡、皮肤红疹、骨折不愈合、骨筋膜室综合征、压迫性神经麻痹等并发症发生情况。结果:复位后即刻测量桡骨高度为10.71±2.25mm,桡骨掌倾角为12.84±3.63°,桡骨尺偏角为22.47±4.31°,均较复位前明显改善,差异有统计学意义(P<0.05)。复位后6月患者Gartland-Werley腕关节功能评分总分显著低于复位前,差异有统计学意义(P<0.05)。且主观评价、客观评价、残余畸形、并发症得分四项指标均明显低于复位前,差异有统计学意义(P<0.05)。根据Gartland-Welley评分结果:优39例,良7例,优良率为100%。结论:郑氏手法整复结合夹板中立板外固定治疗儿童桡骨远端骨骺骨折具有复位成功率高、临床疗效突出、安全性高、并发症少的特点,值得临床推广应用。

早期与延迟手术治疗开放性手部损伤患者临床疗效的研究

目的对比早期手术治疗与延迟手术治疗对开放性手部损伤患者临床疗效的影响。方法回顾性分析2019年1月至2022年1月期间在首都医科大学附属北京友谊医院就诊的483例开放性手部损伤患者的临床资料。根据受伤至手术时间将患者分为早期手术组(受伤距手术时间<6 h,n=251)和延迟手术组(受伤距手术时间6~24 h,n=232)。比较两组患者的损伤程度、伤口感染发生率、手术翻修发生率,以及通过腕关节自评量表(PRWE)评估的手部功能恢复情况。按照损伤程度不同,比较简单损伤与复杂损伤患者手部伤口感染、手术翻修发生率和PRWE腕关节自评量表评分。结果早期手术组与延迟手术组损伤严重程度比较,差异无统计学意义(P>0.05)。两组共发生手部伤口感染65例(13.5%)。简单损伤患者中,早期手术组与延迟手术组的感染发生率分别为17.1%和12.8%;复杂损伤患者中,两组感染率分别为14.3%和10.3%,早期手术组与延迟手术组的感染发生率比较,差异均无统计学意义(P>0.05)。两组共发生手术翻修95例(19.7%)。简单损伤患者中,早期和延迟手术组翻修发生率分别为8.1%和12.8%,复杂损伤患者中,两组翻修发生率分别为22.9%和29.5%;早期手术组与延迟手术组的手术翻修发生率比较,差异均无统计学意义(P>0.05)。简单损伤患者中,早期手术组与延迟手术组的术后PRWE量表评分分别为(7.78±1.87)、(7.93±2.04)分;简单损伤患者中,两组的术后PRWE量表评分分别为(8.07±2.03)、(8.73±3.61)分,早期手术组与延迟手术组的术后PRWE量表评分比较,差异均无统计学意义(P>0.05)。复杂损伤患者的翻修发生率为26.2%,显著高于简单损伤患者(10.2%),PRWE评分为(8.41±1.93)分,显著高于简单损伤患者[(7.85±1.95)分],差异均有统计学意义(P<0.05)。结论手部开放性损伤的延迟手术治疗(6-24 h)不会增加手术的感染或翻修发生率,对手部功能的恢复亦无显著影响,但患者的损伤结构的复杂性以及手术时间对功能结果有显著影响。

开放性创伤性脑损伤合并海水浸泡后颅内感染大鼠模型构建

目的通过构建开放性创伤性脑损伤合并海水浸泡后颅内感染大鼠模型,检测经天然海水浸泡后大鼠颅内感染的发生率及病原菌种类.方法从福建平潭观音奥港口取海水17000 ml,进行海水细菌培养、宏基因组测序和动物模型制作.66只雄性SD大鼠,随机分为3组:TBI+无菌人工海水浸泡(ASI)组(n=6)、对照(sham)+天然海水浸泡(NSI)组(n=30)和TBI+NSI组(n=30).造模后经枕大池抽取脑脊液进行细菌培养,根据培养结果统计感染率及病原菌种类.结果海水宏基因组测序提示,海水菌群结构为弧菌属、假交替单胞菌属、远洋杆菌属、嗜冷菌属等;海水细菌培养提示,样本海水中存在副溶血弧菌、溶藻弧菌、创伤弧菌、大肠杆菌、金黄色葡萄球菌和肺炎克雷伯杆菌等.TBI+NSI组动物中,感染副溶血弧菌感染和大肠杆菌各6只,溶藻弧菌5只,铜绿假单胞菌1只,其中部分大鼠出现混合感染(3只).TBI+NSI组共感染21只,感染率70%(21/30),与sham+NSI组相比(P<0.01);sham+NSI组感染副溶血弧菌2只,大肠杆菌1只,溶藻弧菌1只,肺炎克雷伯杆菌1只,感染率17%(5/30).TBI+ASI组大鼠未出现感染.结论本研究成功建立了开放性创伤性脑损伤合并海水浸泡后颅内感染大鼠模型,初步明确了开放性创伤性脑损伤合并海水浸泡后颅内感染的致病菌多为革兰氏阴性菌,以海洋弧菌和肠道菌群为主.

乳没软膏治疗急性闭合性软组织损伤大鼠的抗炎研究

目的:研究乳没软膏治疗急性闭合性软组织损伤的抗炎镇痛作用。方法:60只斯泼累格·多雷(SD)大鼠(6只备用),分为A组(空白对照组)、B组(模型对照组)、C组(青鹏软膏组)、D组(乳没软膏高剂量组)、E组(乳没软膏中剂量组)、F组(乳没软膏低剂量组);通过建立SD大鼠急性闭合性软组织损伤模型,检测受损组织内肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、前列腺素2(PGE-2)、超氧化物歧化酶(SOD)含量的变化;镜下观察受损组织形态学变化及组织中碱性细胞生长因子(bFGF)含量变化。结果:造模药物干预后,造模组大鼠损伤组织TNF-α、IL-1β、PGE-2含量逐渐下降,其中以C组、D组下降最为明显,B组下降最为缓慢;SOD含量以C组、D组的上升趋势最为明显,B组上升最为缓慢。造模后第2天,各组bFGF蛋白平均光密度值总体比较差异无统计学意义(P>0.05);造模后第7天、第14天,各组bFGF蛋白平均光密度值总体比较差异有统计学意义(P<0.05)。结论:乳没软膏高剂量组与青鹏软膏在抗炎镇痛方面效果相当。

Multiple portions enteral nutrition and chyme reinfusion of a blunt bowel injury patient with hyperbilirubinemia undergoing open abdomen:A case report

Blunt bowel injury(BBI)is relatively rare but life-threatening when delayed in surgical repair or anas-tomosis.Providing enteral nutrition(EN)in BBI patients with open abdomen after damage control surgery is challenging,especially for those with discontinuity of the bowel.Here,we report a 47-year-old male driver who was involved in a motor vehicle collision and developed ascites on post-trauma day 3.Emergency exploratory laparotomy at a local hospital revealed a complete rupture of the jejunum and then primary anastomosis was performed.Postoperatively,the patient was transferred to our trauma center for septic shock and hyperbilirubinemia.Following salvage resuscitation,damage control lapa-rotomy with open abdomen was performed for abdominal sepsis,and a temporary double enterostomy(TDE)was created where the anastomosis was ruptured.Given the TDE and high risk of malnutrition,multiple portions EN were performed,including a proximal portion EN support through a nasogastric tube and a distal portion EN via a jejunal feeding tube.Besides,chyme delivered from the proximal portion of TDE was injected into the distal portion of TDE via a jejunal feeding tube.Hyperbilirubinemia was alleviated with the increase in chyme reinfusion.After 6 months of home EN and chyme reinfusion,the patient finally underwent TDE reversal and abdominal wall reconstruction and was discharged with a regular diet.For BBI patients with postoperative hyperbilirubinemia who underwent open abdomen,the combination of multiple portions EN and chyme reinfusion may be a feasible and safe option.