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Showing papers in "Chinese journal of traumatology in 2003"


Journal Article
TL;DR: Understanding of the occurrence and development of road traffic injuries will contribute to the prevention and control of crash and to the implementation of "everybody has the right to enjoy health" proposed by WHO.
Abstract: The appearance of cars has raised materialistic civilization and living standard to an unprecedented level. Today, it is hard to imagine how we human beings can live without cars. Yet, motor vehicles can cause a great number of deaths and injuries as well as considerable economic losses, which have constituted the global burden. Understanding of the occurrence and development of road traffic injuries will contribute to the prevention and control of crash and to the implementation of "everybody has the right to enjoy health" proposed by WHO.

312 citations


Journal Article
TL;DR: To reduce the incidence of iatrogenic side effects, surgical craniectomy should be performed according to the strict indication and standard and any abuse should be avoided.
Abstract: Objective: To find out the optimal approach to decompress externally the severe injured brain and to avoid possible complications caused by external decompression. Methods: 68 patients who underwent external decompression after traumatic brain injury were admitted into Tianjin Medical University General Hospital for cranioplasty from 1995 to 2001. Complications were retrospectively investigated and analyzed in all patients. The findings were compared between the patients who accepted the decompressive craniectomy in our hospital and in local hospitals. χ 2-test was employed for statistical analysis and complication evaluation. Results: Large craniectomy definitely caused some side effects to patients. Among various complications, several of them showed significantly high incidence (P 0.05) in patients who underwent the decompressive operation in local hospitals such as shunt-dependent hydrocephalous, subdural fluid collection, and CSF leakage from scalp incision. The rest of the complications had no remarkable difference (P 0.05) between the two groups including dilation or/and migration of lateral ventricle underlying the cranial defect, skin flap concavity, encephalomalacia of the decompressive area, seizure and infection. Conclusions: To reduce the incidence of iatrogenic side effects, surgical craniectomy should be performed according to the strict indication and standard and any abuse should be avoided.

85 citations


Journal Article
TL;DR: Osteoporosis influences the quantity and quality of callus during the early period of fracture healing and has no relationship with the expression of BMP-2 or bFGF.
Abstract: Objective To evaluate the effect of osteoporosis on fracture healing through observing the histomorphological changes, bone mineral density of callus and expression and distribution of transforming growth factor beta 1 (TGF-beta1), basic fibroblast growth factor (bFGF) and bone morphogenetic protein-2 (BMP-2) in ovariectomized rats. Methods Sixty female Sprague-Dawley rats (aged 12 weeks and weighing 235 g on average) were randomly divided into an ovariectomized (OVX) group (n=30) and a sham-operated (SO) group (n=30). Ovariectomy was performed in the OVX rats and same incision was made in the SO rats. Three months later, fracture of femoral shaft was made on all the rats. Then they were killed at different time points. Callus formation was observed with histological and immunohistochemical methods. Results A reduction in callus and bone mineral density in the healing femur and a decrease of osteoblasts expressing TGF-beta1 near the bone trabecula were observed in the OVX rats 3-4 weeks after fracture. Histomorphological analysis revealed a higher content of soft callus in the OVX rats than that in the SO rats. Immunohistochemistry results showed that no remarkable difference in expression and distribution of BMP-2 and bFGF between the OVX and SO groups was found. Conclusions Osteoporosis influences the quantity and quality of callus during the early period of fracture healing. The effect of osteoporosis on fracture healing has no relationship with the expression of BMP-2 or bFGF. The decreased expression of TGF-beta1 in osteoblasts may cause a decrease in quality of fracture healing after osteoporosis.

49 citations


Journal Article
TL;DR: HBO therapy has specific curative effects on patients with postbrain injury neural status, and (99m)Tc-ECD SPECT could play an important role in diagnosing postbrain Injury neural status and monitoring the therapeutic effects of HBO.
Abstract: Objective: To evaluate the effects of hyperbaric oxygen (HBO) therapy on patients with postbrain injury neural status. Methods: Two to 4 courses of HBO therapy and/or medications were used to treat 320 patients who were randomly divided into two groups. Assessment was made with 99m Tc-ethyl cysteinate dimer ( 99m Tc-ECD) single photon emission computed tomography (SPECT) before and after treatment. Results: There was a significant difference between the HBO therapy group and the non-HBO therapy group. HBO therapy was superior to medication treatment alone in the recovery of clinical symptoms, control of epilepsy, and resolution of hydrocephalus (P 0.01). Conclusions: HBO therapy has specific curative effects on patients with postbrain injury neural status, and 99m Tc-ECD SPECT could play an important role in diagnosing postbrain injury neural status and monitoring the therapeutic effects of HBO.

26 citations


Journal Article
TL;DR: History of agricultural labor, history of lower limb injury, flatfoot, less running exercise before entry into the army and lower BMI were risk factors of the overuse injuries and the young people with good physical ability and shapely body type should be selected during conscription.
Abstract: Objective To assess the incidence, types and risk factors of military training-related injuries in recruits of Chinese People's Armed Police Forces (CPAPF). Methods A cohort study was made on the risk factors of injuries in 805 male recruits during the military training from December 25, 1999 to December 25, 2000. Results A total of 111 recruits (14%) experienced one or more injuries, and the cumulative incidence was 16.1 injuries per 100 soldiers in a year. And 77.7% of the injuries belonged to overuse injuries of the skeletal and muscular systems, the most common type of which was stress fractures. Most injuries occurred in the 3rd month of training. Univariate analysis and logistic regression analysis of possible risk factors for overuse injuries were carried out, and a number of risk factors were identified: history of agricultural labor, history of lower limb injury, flatfoot and less running exercise before entry into the army. But a suitable body mass index (BMI) was a protective factor. Examination of age, body height, smoking, body flexibility and frequency of 2-mile running revealed no significant association with the injuries. Conclusions History of agricultural labor, history of lower limb injury, flatfoot, less running exercise before entry into the army and lower BMI were risk factors of the overuse injuries. In order to decrease the incidence of overuse injuries, the young people with good physical ability and shapely body type should be selected during conscription. During the training, nutrition should be improved so as to decrease the incidence of injuries.

24 citations


Journal Article
TL;DR: SP has up-regulation effect on the gene expression of TGFbeta-1,TGFR-1 and TGFR-2 in fibroblasts from rat's granulation tissues in vitro, and the effect is related to different stimulating concentrations of SP.
Abstract: OBJECTIVE To investigate the effect of substance P (SP) on gene expression of transforming growth factor beta-1 (TGFbeta-1), transforming growth factor receptor-1 (TGFR-1) and transforming growth factor receptor-2 (TGFR-2) in fibroblasts cultured in vitro from rat's granulation tissues. METHODS The fibroblasts from the granulation tissues in the skeletal muscle of rat's hind limbs injured by formaldehyde were cultured in vitro. When different concentrations (10(-9)-10(-5) mol/L) of SP were added into the culture medium, the changes of gene expression of TGFbeta-1, TGFR-1 and TGFR-2 in the cultured fibroblasts were observed with reverse transcription polymerase chain reaction at different intervals (0, 3, 6, 12 and 24 hours after incubation). RESULTS The gene expression of TGFbeta-1, TGFR-1 and TGFR-2 in the fibroblasts cultured from rat's granulation tissues was up-regulated by SP. The peak level of the mRNA expression was found at 10(-8) mol/L SP and the up-regulation effect was not found at 10(-5) mol/L and 10(-6) mol/L. The peak levels of gene expression of TGFbeta-1, TGFR-1 and TGFR-2 in the fibroblasts treated with SP were achieved at 6 and 12 hours, respectively. CONCLUSIONS SP has up-regulation effect on the gene expression of TGFbeta-1, TGFR-1 and TGFR-2 in fibroblasts from rat's granulation tissues in vitro, and the effect is related to different stimulating concentrations of SP. It may be concerned with proliferation and differentiation of fibroblasts and formation of scar tissues during wound healing.

24 citations


Journal Article
TL;DR: The crashes are related to the characteristics of geography, climate, society activity of people, and the sense of traffic safety, the basic traffic construction and management in Chongqing.
Abstract: OBJECTIVE: To study the epidemiological characteristics and preventive methods of road traffic crashes in a mountain city in western China through sampling investigation of traffic crashes in different regions of Chongqing city in recent years. METHODS: Two police teams of traffic management in downtown, two teams in suburb, one team in county and one freeway team were randomly selected, and road traffic crashes between 1988 and 1997 were investigated and analyzed. RESULTS: A total of 13121 road traffic crashes with 6201 crashes with casualties were analyzed. The incidence of crashes was higher in May, June and July, and on Friday and Wednesday and at 8:00-12:00 and 14:00-18:00 within a day. Casualties were 44.0% in pedestrians and 42.5% in passengers of total casualties. The deaths and severe injuries in pedestrians were 59.1% of total deaths and 56.4% of total severe injuries. The age of drivers and passengers were mainly at 18-30 years, followed by 31-40 years. People over 60 years old accounted for 24.1% of total pedestrian casualty. Head injury was the most common reason for deaths. The main reasons for these crashes were improper driving and violating traffic laws. Violating traffic laws by pedestrian was one of the main reasons for pedestrian casualty. CONCLUSIONS: The crashes are related to the characteristics of geography, climate, society activity of people, and the sense of traffic safety, the basic traffic construction and management in Chongqing. The traffic casualty of pedestrian is a big problem in Chongqing. To prevent and decrease road traffic injuries effective methods should be worked out and propaganda on traffic safety and traffic management should be strengthened according to different characteristics of different regions. To strengthen the first aid and treatment of cranium-brain injury and chest-back injury is also helpful in decreasing traffic deaths.

20 citations


Journal Article
Wei Guan1, Yi-lin Yang, Wei-min Xia, Lu Li, De-sheng Gong 
TL;DR: Serum NSE is one of the valuable neurobiochemical markers for assessment of the severity of brain injury and outcome prediction and most patients with poor outcomes had persisting or secondary elevated NSE values.
Abstract: OBJECTIVE To study the association between serum neuron-specific enolase (NSE) and the extent of brain damage and the outcome after acute traumatic brain injury (TBI). METHODS The release patterns of serum NSE in 78 patients after acute TBI were analyzed by using the enzyme linked immunosorbent assay. The levels of NSE were compared with Glasgow coma scale, the category of brain injury and the outcome after 6 months of injury. RESULTS There were different NSE values in patients with minor (12.96 microg/L+/-2.39 microg/L), moderate (23.44 microg/L+/-5.33 microg/L) and severe brain injury (42.68 microg/L+/-4.57 microg/L). After severe TBI, the concentration of NSE in patients with epidural hematomas was 13.38 microg/L+/-4.01 microg/L, 24.03 microg/L+/-2.85 microg/L in brain contusion without surgical intervention group, 55.20 microg/L+/-6.35 microg/L in brain contusion with surgical intervention group, and 83.85 microg/L+/-15.82 microg/L in diffuse brain swelling group. There were close correlations between NSE values and Glasgow coma scale (r=-0.608, P<0.01) and the extent of brain injury (r=0.75, P<0.01). Patients with poor outcome had significantly higher initial and peak NSE values than those with good outcome (66.40 microg/L+/-9.46 microg/L, 94.24 microg/L+/-13.75 microg/L vs 32.16 microg/L+/-4.21 microg/L, 34.08 microg/L+/-4.40 microg/L, P<0.01, respectively). Initial NSE values were negatively related to the outcome (r=-0.501, P<0.01). Most patients with poor outcomes had persisting or secondary elevated NSE values. CONCLUSIONS Serum NSE is one of the valuable neurobiochemical markers for assessment of the severity of brain injury and outcome prediction.

19 citations


Journal Article
TL;DR: Greater omentum provides a well-vascularized tissue with lymphatic ducts for wound coverage that has strong resistance against infection and is an ideal tissue in filling cavities and repairing defects, especially in covering large and irregular defects that can not be treated with skin or muscle flaps.
Abstract: Objective: To evaluate the clinical efficacy of greater omentum in reconstruction of refractory wounds. Methods: From August 1988 to May 2001, 20 patients with refractory wound underwent pedicle or microvascular free transfer of the greater omentum. Indications of surgery were electrical injury of the wrist and hand in 9 patients, electrical injury of the scalp and cranial bones in 3, avulsion injury of the scalp in 2, radiation-related ulcer of the chest wall in 2, ulcer and osteomyelitis following resection of the sternum sarcoma in 1, electrical injury of the abdomen in 1, bone and soft tissue defects following compound fracture of the leg in 1, and extensive scar and ulcer of the leg and footdrop following trauma in 1. Severe infection and extensive tissue necrosis were present prior to surgical operation in 12 patients. Eleven patients were treated with pedicled omental flaps, and 9 patients with free omental flaps. The size of the omental flaps ranged from 20 cmtimes;12 cm to 38 cmtimes;23 cm. Results: All the omental flaps survived. Healing at the first intention of the wounds was achieved in 17 cases. The on-top skin grafts resulted in partial necrosis of lipid liquefaction developed in the omentum and healed with dressing change in 2 cases. A sinus tract of osteomyelitis occurred in one case and healed after delayed excision of the necrosed bone. Follow-up study of all cases from 3 to 24 months showed no recurrent wounds and post-operative abdominal complication. Recovery with acceptable appearance and restoration of function was satisfactory. Conclusions: Greater omentum provides a well-vascularized tissue with lymphatic ducts for wound coverage. It has strong resistance against infection. It is very malleable and can be molded easily. Therefore it is an ideal tissue in filling cavities and repairing defects, especially in covering large and irregular defects that can not be treated with skin or muscle flaps.

19 citations


Journal Article
TL;DR: The expression of some genes changes significantly in the early stage after spinal cords injury, which indicates the complexity of secondary spinal cord injury.
Abstract: Objective To study the changes of the gene expression pattern of spinal cord tissues in the early stage after injury by DNA microarray (gene chip). Methods The contusion model of rat spinal cord was established according to Allen's falling strike method and the gene expression patterns of normal and injured spinal cord tissues were studied by gene chip. Results The expression of 45 genes was significantly changed in the early stage after spinal cord injury, in which 22 genes up-regulated and 23 genes down-regulated. Conclusions The expression of some genes changes significantly in the early stage after spinal cord injury, which indicates the complexity of secondary spinal cord injury.

19 citations


Journal Article
TL;DR: Optimized design parameters of a three-dimensional porous biomaterial would give full scope to the role of BMP as an osteoinductive growth factor and accelerate degradation of the biomaterials.
Abstract: Objective: To explore the method to repair bone defect with bone-morphogenetic-protein loaded hydroxyapatite/collagen-poly(L-lactic acid) composite. Methods: 18 adult beagle dogs were randomly divided into 3 groups. In Group A, bone-morphogenetic-protein (BMP) loaded hydroxyapatite/collagen-poly(L-lactic acid) (HAC-PLA) scaffold was implanted in a 2 cm diaphyseal defect in the radius. In Group B, unloaded pure HAC-PLA scaffold was implanted in the defects. No material was implanted in Group C (control group). The dogs were sacrificed 6 months postoperatively. Features of biocompatibility, biodegradability and osteoinduction were evaluated with histological, radiological examinations and bone mineral density (BMD) measurements. Results: In Group A, the radius defect healed after the treatment with BMP loaded HAC-PLA. BMD at the site of the defect was higher than that of the contralateral radius. Fibrous union developed in the animals of the control group. Conclusions: BMP not only promotes osteogenesis but also accelerates degradation of the biomaterials. Optimized design parameters of a three-dimensional porous biomaterial would give full scope to the role of BMP as an osteoinductive growth factor.

Journal Article
TL;DR: Standard large trauma craniotomy significantly reduces the mortality of patients with severe TBI without serious complications, but does not improve the life quality of the patients.
Abstract: OBJECTIVE To study the effect of standard large trauma craniotomy (SLTC) on outcomes of patients with severe traumatic brain injury (TBI) (GCS<=8). METHODS 230 patients with severe TBI were randomly divided into two groups. 115 patients underwent SLTC (10 cm x 12 cm) as an SLTC group, and other 115 patients underwent temporo-parietal or fronto-temporal craniotomy (6 cm x 8 cm) according to the position of hematomas as a routine craniotomy (RC) group. Other treatments were identical in two groups. According to Glasgow outcome scale (GOS), the prognosis of the patients was evaluated and the complications were compared between two groups. RESULTS 27 patients got good outcome and moderate disability (23.5%), 40 severe disability and vegetative survival (34.8%), and 48 died (41.7%) in SLTC group. 21 patients got good outcome and moderate disability (18.3%), 28 severe disability and vegetative survival (24.3%), and 66 died (57.4%) in RC group. The incidence of incision hernia was lower in SLTC group than in RC group. However, the incidence of operative encephalocele, traumatic epilepsy and intracranial infection were not different in two groups. CONCLUSIONS Standard large trauma craniotomy significantly reduces the mortality of patients with severe TBI without serious complications, but does not improve the life quality of the patients.

Journal Article
TL;DR: Proton transportation across IMM and mitochondrial H(+)-ATPase activity are significantly decreased in endotoxic shock.
Abstract: OBJECTIVE To investigate the changes of proton transportation across the inner mitochondrial membrane (IMM) and H(+)-ATPase of hepatocytes in endotoxic shock rats. METHODS Endotoxin from E. Coil of 5.0 mg/kg or saline of 1 ml/kg was injected into the femoral vein. The rats were sacrificed pre-injection and 1, 3, 5, 8 hours after injection, and plasma and liver tissue samples were collected respectively. The liver tissue samples were used for preparation of mitochondria and submitochondrial particles (SMPs). The proton-translocation of SMPs and H(+)-ATPase, phospholipase A(2) (PLA(2)) activities and malondialdehyde (MDA) content, membrane fluidities of different level of mitochondria membrane and plasma MDA content were assayed. RESULTS (1) Five hours after E. Coli. O111B4 injection, the maximum fluorescence quenching ACMA after adding ATP, nicotinamide adenin dinucleoacid hydrogen (NADH), and the succinate were significantly decreased (P<0.05). The time of maximum fluorescent quenching and the half time of fluorescent quenching were significantly prolonged (P<0.01), especially when NADH was used as a substrate. (2) The mitochondrial H(+)-ATPase activity was significantly increased at early stage of endotoxic shock (P<0.05), and significantly decreased at late stage of endotoxic shock (P<0.01). (3) The mitochondrial membrane bound PLA(2) activity, plasmal and mitochondrial MDA content were significantly increased and succinate dehydrogenase (SDH) activity of mitochondria decreased markedly in endotoxic shock rats (P<0.05). (4) The mitochondrial membrane fluidity of different lipid regions was decreased, especially in the head of phospholipid. CONCLUSIONS Proton transportation across IMM and mitochondrial H(+)-ATPase activity are significantly decreased in endotoxic shock.

Journal Article
TL;DR: The rejection in deep tissues should be monitored in controlling the rejection of hand allograft.
Abstract: Objective: To observe the survival of hand allograft under the state of immunosuppression and the pathological changes of rejection in the recovery process. Methods: The biopsies of the skin, nerve, muscle, tendon and bone tissue of hand allografts during different stages from 1 day to 7 months after operation were observed using routine histological technique. Results: No significant changes due to rejection in skin, nerve, muscle and bone tissue were observed. But different degrees of weak rejective changes were found on the wall of blood vessels; in the muscle and nerve the reactions were markedly stronger than those found in skin tissues. Conclusions: The rejection in deep tissues should be monitored in controlling the rejection of hand allograft.

Journal Article
TL;DR: AVP may play an important role in the pathophysiological process in patients with acute traumatic cerebral injury in the early stage, and the severer the cerebral injury is, the higher the level of AVP is, which indicates that the levelof AVP may be one of the severity indices of traumatic cerebral Injury in elderly patients.
Abstract: OBJECTIVE To investigate the changes and clinical significance of arginine vasopressin (AVP) in elderly patients with acute traumatic cerebral injury. METHODS With radioimmunoassay, the plasma levels of AVP were measured in 32 elderly patients with acute traumatic cerebral injury, 30 traumatic patients without cerebral injury and 30 healthy elderly volunteers, respectively. RESULTS The plasma level of AVP in patients with acute traumatic cerebral injury in the early stage (48.30 ng/L +/- 8.28 ng/L) was much higher than that of the traumatic patients without cerebral injury (25.56 ng/L +/- 4.64 ng/L, P<0.01), which was much higher than that of the healthy volunteers (5.06 ng/L +/- 4.12 ng/L, P<0.01). The level of AVP in the patients with acute traumatic cerebral injury was negatively related with GCS scores. CONCLUSIONS AVP may play an important role in the pathophysiological process in patients with acute traumatic cerebral injury in the early stage. The severer the cerebral injury is, the higher the level of AVP is, which indicates that the level of AVP may be one of the severity indices of traumatic cerebral injury in elderly patients.

Journal Article
TL;DR: Chitosan-collagen film conduit can be used to bridge peripheral nerve defect and the quality of nerve regeneration was similar to that of the control group.
Abstract: Objective: To seek new method for the treatment of peripheral nerve injury. Methods: In rat model with sciatic nerve defect, chitosan collagen film was sutured into conduit to bridge 5 mm , 10 mm nerve defects. Rats that underwent end to end anastomosis were taken as controls. General observation, electrophysiological study, histological study and image analysis were performed at 4, 8, 12 weeks postoperatively. Results: In 5 mm nerve defects, the quality of nerve regeneration was similar to that of the control group. For 10 mm nerve defect, nerve regeneration was inferior to that of the control group. Chitosan collagen film obviously degraded at 12 weeks postoperatively. Conclusions: Chitosan collagen film conduit can be used to bridge peripheral nerve defect.

Journal Article
TL;DR: Ganglioside GM1 does have obvious neuroprotective effect on early TBI, and changes of mean arterial pressure, contents of water, lactic acid and lipid peroxidation in the injured cerebral tissues were observed.
Abstract: OBJECTIVE To observe the effects of ganglioside GM1 on reduction of brain edema and amelioration of cerebral metabolism after traumatic brain injury (TBI). METHODS An acute experimental closed TBI model in rats was induced by a fluid-percussion brain injury model. At five and sixty minutes after TBI, the animals were intraperitoneally injected by ganglioside GM1 (30 mg/kg) or the same volume of saline. At the 6th hour after TBI, effects of ganglioside GM1 or saline on changes of mean arterial pressure (MAP), contents of water, lactic acid (LA) and lipid peroxidation (LPO) in the injured cerebral tissues were observed. RESULTS After TBI, MAP decreased and contents of water, LA and LPO increased in brain injury group; however, MAP was back to normal levels and contents of water, LA and LPO decreased in ganglioside GM1 treated group, compared with those in brain injury group (P 0.05) was observed. CONCLUSIONS Ganglioside GM1 does have obvious neuroprotective effect on early TBI.

Journal Article
TL;DR: Bax and Bcl-2 proteins play an important role in the apoptotic regulation of radiation compound wound healing in rats, which might be an important reason for radiation-induced delayed wound healing.
Abstract: Objective To study the relationship between the expression of Bax, Bcl-2 proteins, and apoptosis in radiation compound wound healing of rats. Methods Apoptosis, Bax and Bcl-2 proteins were estimated by in situ terminal labeling (TUNEL) and immunohistochemical methods. Results (1) Changes of the apoptosis in wound healing showed three typical characteristics: early occurrence, high frequency and delayed disappearance after radiation to rats when compared with those of simple wound group, which might be an important reason for radiation-induced delayed wound healing. (2) The expression of Bax protein increased evidently with the increment of apoptosis and showed a good corresponding relationship with the apoptotic frequency in the process of wound healing. While the expression of Bcl-2 protein decreased obviously as the apoptosis reached a maximum and showed increasing tendency up to normal level when the apoptosis decreased distinctively. Conclusions Bax and Bcl-2 proteins play an important role in the apoptotic regulation of radiation compound wound healing in rats.

Journal Article
TL;DR: Standard large trauma craniotomy can attenuate brain hernia and the mortality of the patients with acute subdural hematoma and the incidence of complication can also be decreased, but the long term life quality of the Patients can not be improved.
Abstract: Objective: To compare the therapeutic effect and indication between standard large trauma craniotomy and routine craniotomy Methods: There were 97 patients in the standard large trauma craniotomy group and 110 patients in the routine craniotomy group The mortality, postoperative ICP (intracranial pressure), ratio of pupil rebound, complication and results of six month follow up after operation were compared between the two groups Results: Fifteen patients ( 156 %) died in the standard large trauma craniotomy group and 30 ( 277 %) in the routine craniotomy group The postoperative mean ICP was 375 kPa±189 kPa in the standard large trauma craniotomy group and 511 kPa±157 kPa in the routine craniotomy group The pupil rebound was found in 47 patients ( 610 %) in the standard large trauma craniotomy group and in 41 patients ( 461 %) in the routine craniotomy group (P 001 ) The rate of complication was lower in the standard large trauma craniotomy group, but no obvious difference in long term therapeutic effect was found between the two groups Conclusions: Standard large trauma craniotomy can attenuate brain hernia and the mortality of the patients with acute subdural hematoma The incidence of complication can also be decreased But the long term life quality of the patients can not be improved

Journal Article
TL;DR: Post-traumatic endophthalmitis with intraocular foreign bodies (IOFBs) deserves great attention because of its high incidence and poor prognosis and it should be performed as soon as possible.
Abstract: Objective: To evaluate the outcome and analyze the methods of surgical treatment of traumatic endophthalmitis following penetrating eye injuries with retained eye foreign bodies. Methods: A total of 62 consecutive cases (58 men, 4 women) from January 1999 to December 2001 with IOFBs following penetrating eye injuries were retrospectively studied. The ages ranged from 8 to 46 years (mean 23 years). Sixty patients (63 eyes) underwent pars plana vitreotomy and 1 patient underwent external magnet extraction. The follow up ranged from 3 to 36 months (mean 12.5 months). Results: Ten eyes developed endophthalmitis, among which 7 ( 10.94 %) were diagnosed preoperatively. The most frequently cultured organism was Staphylococcus epidermis ( 44.44 %, 4/9). Postoperatively, retinal detachment due to vitreoretinal proliferation occurred in 5 patients with endophthalmitis and in 9 patients without endophthalmitis. All the retinal detachments were reattached with additional vitreoretinal surgery. Two eyes with endophthalmitis and two without endophthalmitis were eviscerated. Conclusions: Post traumatic endophthalmitis with intraocular foreign bodies (IOFBs) deserves great attention because of its high incidence and poor prognosis. Vitrectomy is suggested for the treatment of IOFBs and its complications, and it should be performed as soon as possible. Routine intravenous administration of antibiotics combined with periocular injection and topical antibiotics postoperatively are recommended.

Journal Article
TL;DR: PMNs accumulation in the lungs is related to increased ICAM-1 expression on pulmonary microvascular endothelial cells and CD11b/CD18 expression on PMN at the early stage of burn injury.
Abstract: Objective: To investigate the role of intercellular adhesion molecule 1 (ICAM 1) in the accumulation of polymorphonuclear neutrophils (PMN) in the lungs at the early stage of burns. Methods: Myeloperoxidase content in lung tissues and bronchoalveolar lavage fluid (BALF) were detected. ICAM 1 and its mRNA expression in lung tissues were determined by immunohistochemical method and in situ hybridization. CD11b/CD18 expression on the peripheral PMNs was measured by flowcytometry. Results: The levels of myeloperoxidase in lung tissues and BALF after burn injury were markedly higher than those of control. Expression of ICAM 1 and its mRNA in the lung tissues and CD11b/CD18 on peripheral PMNs surface was significantly increased at 2, 6, 12, 24 h after burns. Conclusions: PMNs accumulation in the lungs is related to increased ICAM 1 expression on pulmonary microvascular endothelial cells and CD11b/CD18 expression on PMN at the early stage of burn injury.

Journal Article
TL;DR: Treatment with nimodipine can dramatically reduce the damage of brain edema and demonstrate neuroprotective effect on brain edma by inhibiting the excess of Ca(2+) influx and reducing the permeability of BBB.
Abstract: Objective To explore the mechanism and type of acute infectious brain edema induced by injection of pertussis bacilli (PB) in rat neocortex, to study the neuroprotective effect of non-competitive antagonist of N-methl-D-aspartate (NMDA) receptor (MK-801) and antagonist of Ca(2+) channels (nimodipine) on brain edema, and to investigate the relationship between percentage of water content and cytosolic free calcium concentration ([Ca(2+) ](i)) in synaptosomes or content of Evans Blue (EB) Methods 95 SD rats were randomly divided into five groups, ie, normal control group, sham-operated control group, PB group, nimodipine treatment group and MK-801 pretreatment group The acute infectious brain edema was induced by injection of PB into the rats Quantitative measurements of water content and the concentration of EB were performed [Ca(2+) ](i) was determined in calcium fluorescent indication Fura-2/AM loaded neuronal synaptosome with a spectrofluorophotometer To observe the effect of MK-801 and nimodipine, we administered MK-801 48 hours and 24 hours before the injection of PB in MK-801 pretreatment group, and nimodipine after the injection of PB in nimodipine treatment group The specific binding of NMDA receptor was measured with [(3)H]-MK-801 in the neuronal membrane of cerebral cortex Results The levels of water content and EB content of brain tissues, and [Ca(2+) ](i) in the neuronal synaptosomes increased more significantly in the PB-injected cerebral hemisphere in the PB group than those of normal control group and sham-operated control group (P 005) Conclusions The changes in the permeability of blood-brain barrier (BBB) and Ca(2+)-overload may participate in the pathogenesis of infectious brain edema Treatment with nimodipine can dramatically reduce the damage of brain edema and demonstrate neuroprotective effect on brain edema by inhibiting the excess of Ca(2+) influx and reducing the permeability of BBB MK-801 pretreatment may inhibit the delayed Ca(2+) influx into the neurons The infectious brain edema is not only cytotoxic brain edema (intracellular edema) but also vasogenic brain edema (extracellular edema) followed by earlier BBB breakdown, so infectious brain edema is complicated with brain edema

Journal Article
TL;DR: Complicated TAA and TAVF in different sites should be treated with different methods.
Abstract: Objective: To evaluate the surgical methods and the outcome of management for traumatic arterial aneurysm (TAA) and traumatic arterioveneus fistula (TAVF) Methods: A total of 121 patients with TAA or TAVF were treated by surgery Clinical, operative and postoperative data were collected and analyzed retrospectively Results: The surgical techniques included aneurysmectomy and arterial end-to-end anastomosis or vascular grafting or artery ligation, aneurysm ligation and bypass, vascular repair, fistula excision and vascular ligation or vascular grafting or repair and so on One patient died (083%) The follow-up rates of TAA and TAVF were 657% and 60% respectively Conclusions: Complicated TAA and TAVF in different sites should be treated with different methods

Journal Article
TL;DR: In both female and male students, the prevalence of chondromalacia patella is higher in gymnastic department than nongymnastic department, and the correlation with sports injury is an important cause.
Abstract: Objective To study the prevalence of chondromalacia patella among college students and the correlation with sports injury Methods 354 students from gymnastic department and 429 from nongymnastic department with knee joint pain were selected 184 students from gymnastic department and 342 from nongymnastic department were checked randomly by a surgeon 77 patients (37 males, 40 females) from gymnastic department and 119 patients (62 males, 57 females) from nongymnastic department were diagnosed as chondromalacia patellae The amount of exercise and the occurrence of sports injury were investigated in each student All data were analyzed with SPSS 100 statistical software Results The prevalence of chondromalacia patella was 201% in female students and 116% in male students from gymnastic department, and 561% in female students and 492% in male students from nongymnastic department The amount of exercise and the occurrence of sports injury to the knee joint in students from gymnastic department were greater than those from nongymnastic department Conclusions In both female and male students, the prevalence of chondromalacia patella is higher in gymnastic department than nongymnastic department Sports injury is an important cause of chondromalacia patella

Journal Article
TL;DR: Local application of adenovirus-mediated VEGF165 cDNA may efficiently improve the survival of ischemic skin flaps through local application of vascular endothelial growth factor (VEGF) via adenova-mediated gene transfer.
Abstract: Objective: To evaluate the effect of local application of vascular endothelial growth factor ( VEGF ) via adenovirus-mediated gene transfer on survival of full thickness flaps selected randomly in rats. Methods: Thirty Sprague-Dawley rats weighing 480-520 g were used in this study. A dorsal flap (8 cm × 2 cm) in full thickness with the pedicle located at the level of the iliac crest was designed. Then the rats received 1 012 pfu replication-deficient recombinant adenovirus carrying VEGF ( AdCMV-VEGF group, n = 10 ), 1012 pfu recombinant β-galactosidase adenovirus ( AdCMV-Gal group, n = 10) and 1 ml saline (saline group, n = 10), respectively, in the distal two thirds of the proposed flap by means of subdermal injection at 8 different locations. Three days after treatment, the flaps were elevated as originally designed and sutured back in situ. The survival rate of the flaps was evaluated on day 7 after operation. Results: The survival rate of the flaps in the AdCMV-VEGF group increased significantly as compared with those of the AdCMV-Gal group (P 0.01) and the saline group ( P 0.01). Immunohistochemical staining showed that VEGF was expressed in the survival flaps injected with AdCMV-VEGF. Histological analysis showed that more granulation tissues and angiogenesis were observed in the AdCMV-VEGF group than those in the AdCMV-Gal and the saline groups. Conclusions: Local application of adenovims-mediated VEGF165 cDNA may efficiently improve the survival of ischemic skin flaps.

Journal Article
TL;DR: In this article, the effects of exogenous basic fibroblast growth factor (bFGF) on biological characteristics of rat osteoblasts cultured in vitro were investigated, and it was shown that bFGF (5-50 ng/ml) could stimulate the growth and differentiation of osteoblast cells.
Abstract: Objective: To elucidate the effects of exogenous basic fibroblast growth factor ( bFGF ) on biological characteristics of rat osteoblasts cultured in vitro. Methods: The osteoblasts isolated from a Sprague-Dawley rat and cultured in vitro were treated with different concentrations of bFGF (5-50 ng/ml) respectively. At 24 hours after treatment, the proliferating cell nuclear antigen was measured with immunocytochemistry, alkaline phosphatase ( ALP) activity was determined and the expression of transforming growth factor beta 1 (TGF-β1) was detected to observe the effects of bFGF on growth and differentiation of osteoblasts. Results: bFGF ( 5-50 ng/ml ) could obviously promote the growth of osteoblasts. The intracellular expression of TGF-β, mRNA increased significantly, but the intracellular ALP content decreased. Conclusions: bFGF can obviously stimulate the proliferation of osteoblasts and promote the synthesis of TGF-β1, but cannot promote the differentiation of osteoblasts.

Journal Article
TL;DR: SF has a protective effect on gastrointestinal tract and can reduce inflammatory actions and its potential mechanism is investigated.
Abstract: Objective: To investigate the effect of Shen-Fu (SF) injection on gastrointestinal tract injury and its potential mechanism. Methods: Thirty-eight patients undergoing elective open heart surgery were assigned to Group C (control group, n = 18) and Group SF (n = 20) randomly. In Group SF, the patients received intravenous injection of SF (0.5 ml/kg) at the beginning of the surgery followed by a continuous infusion of 100 ml SF (1.0 ml/kg) solution diluted by saline at a rate of 0.004 ml · Kg-1 · min-1 with a Grasby pump. The control group was injected with normal saline in the same volume. Gastric intramucosal pH (pHi), activity of blood diamine oxidase ( DAO ), and concentrations of blood LPS and IL-6 were measured before CPB ( S0) and 1 h ( S1 ) and 2 h ( S2) after aortic declamping, respectively. Results: In Group C, pHi value was significantly lower at S1 and S2 than at S0 ( mean P 0.01) and blood DAO and concentrations of LPS and IL-6 were significantly higher at S1 and S2 than at S0 ( meanP 0.01). In Group SF, pHi was obviously lower at S1 and S2 than at S0(P 0.05) but LPS and IL-6 levels and DAO were higher at S, (mean P0.05). Blood DAO and LPS level demonstrated significant negative correlations with pHi ( mean P 0.01) while LPS concentration showed a positive correlation with blood DAO (P 0.01) and IL-6 concentration (P 0.05). At S1 and S2 after aortic declamping, the levels of pHi were higher in Group SF than in Group C (mean P 0.01 ) but DAO and LPS and IL-6 levels were significantly lower in Group SF than in Group C ( P 0.01). Conclusions: SF has a protective effect on gastrointestinal tract and can reduce inflammatory actions.

Journal Article
TL;DR: In the process of wound healing after alkali burn, the expression of laminin and fibronectin increases dramatically, which suggests that laminIn and fibRONectin may participate in the processof corneal wound healing.
Abstract: Objective: To observe the expression of laminin and fibronectin in alkali burned corneas in rats.Methods: A total of 18 normal Wistar rats were randomly divided into 6 groups (n=3 in each group). For each rat, one eye was injured by alkali burn, the other one was taken as the normal control. Then all the corneas were surgically removed and the expression of laminin and fibronectin was observed with immunohistochemistry respectively at 7 hours, 1 day, 3 days, 7 days, 14 days and 28 days after alkali burn. Results: Compared with that of the normal controls, the expression of laminin and fibronectin of the burned eyes was dramatically higher at 7 hours, reached peak at 14 days and decreased to the normal level at 28 days after alkali burn. Conclusions: In the process of wound healing after alkali burn, the expression of laminin and fibronectin increases dramatically, which suggests that laminin and fibronectin may participate in the process of corneal wound healing.

Journal Article
TL;DR: Wound Healing may be accelerated by applying a hydrocolloid occlusive dressing on burn surfaces after they are cleaned with EOW.
Abstract: Objective: To study the efficacy of electrolyzed oxidizing water ( EOW ) and hydrocolloid occlusive dressings in the acceleration of epithelialization in excised burn-wounds in rats. Methods: Each of the anesthetized Sprague-Dawley rats (n = 28) was subjected to a third-degree burn that covered approximately 10% of the total body surface area. Rats were assigned into four groups: Group Ⅰ ( no irrigation), Group Ⅱ (irrigation with physiologic saline), Group Ⅲ ( irrigation with EOW ) and Group Ⅳ ( hydrocolloid occlusive dressing after EOW irrigation). Wounds were observed macroscopically until complete epithelialization was present, then the epithelialized wounds were examined microscopically. Results: Healing of the burn wounds was the fastest in Group Ⅳ treated with hydrocolloid occlusive dressing together with EOW. Although extensive regenerative epidermis was seen in each Group, the proliferations of lymphocytes and macrophages associated with dense collagen deposition were more extensive in Group Ⅱ, Ⅲ and IV than in Group Ⅰ. These findings were particularly evident in Group Ⅲ and Ⅳ. Conclusions: Wound Healing may be accelerated by applying a hydrocolloid occlusive dressing on burn surfaces after they are cleaned with EOW.

Journal Article
TL;DR: The technique of monitoring PbtO2 and the brain temperature is safe and reliable, and has important clinical significance in judging disease condition and instructing clinical therapy.
Abstract: Objective: To study the changes of partial pressure of brain tissue oxygen (PbtO 2) and brain temperature in acute phase of severe head injury during mild hypothermia therapy and the clinical significance Methods: One hundred and sixteen patients with severe head injury were selected and divided into a mild hypothermia group (n=58), and a control group (n=58) according to odd and even numbers of hospitalization While mild hypothermia therapy was performed PbtO 2 and brain temperature were monitored for 1 7 days (mean=86 hours), simultaneously, the intracranial pressure, rectum temperature, cerebral perfusion pressure, PaO 2 and PaCO 2 were also monitored The patients were followed up for 6 months and the prognosis was evaluated with GOS (Glasgow outcome scale) Results: The mean value of PbtO 2 within 24 hour monitoring in the 116 patients was 137 mm Hg ± 494 mm Hg , lower than the normal value (16 mm Hg ± 40 mm Hg ) The time of PbtO 2 recovering to the normal value in the mild hypothermia group was shortened by 10± 415 hours compared with the control group (P 005 ) The survival rate of the mild hypothermia group was 6043 %, higher than that of the control group ( 4655 %) After the recovery of the brain temperature, PbtO 2 increased with the rise of the brain temperature Conclusions: Mild hypothermia can improve the survival rate of severe head injury The technique of monitoring PbtO 2 and the brain temperature is safe and reliable, and has important clinical significance in judging disease condition and instructing clinical therapy