Characteristics of Visual Evoked Potential in Different Parts of Visual Impairment / 法医学杂志

OBJECTIVES@#To study the quantitative and qualitative differences of visual evoked potential (VEP) in monocular visual impairment after different parts of visual pathway injury.@*METHODS@#A total of 91 subjects with monocular visual impairment caused by trauma were selected and divided into intraocular refractive media-injury group (eyeball injury group for short), optic nerve injury group, central nervous system injury and intracranial combined injury group according to the injury cause and anatomical segment. Pattern Reversal visual evoked potential (PR-VEP) P100 peak time and amplitude, Flash visual evoked potential (F-VEP) P2 peak time and amplitude were recorded respectively. SPSS 26.0 software was used to analyze the differences of quantitative (peak time and amplitude) and qualitative indexes (spatial frequency sweep-VEP acuity threshold, and abnormal waveform category and frequency) of the four groups.@*RESULTS@#Compared with healthy eyes, the PR-VEP P100 waveforms of the intraocular eyeball injury group and the F-VEP P2 waveforms of the optic nerve group showed significant differences in prolonged peak time and decreased amplitude in injured eyes (P<0.05). The PR-VEP amplitudes of healthy eyes were lower than those of injured eyes at multiple spatial frequencies in central nervous system injury group and intracranial combined injury group (P<0.05).The amplitude of PR-VEP in patients with visual impairment involving central injury was lower than that in patients with eye injury at multiple spatial frequencies. The frequency of VEP P waveforms reaching the threshold of the intraocular injury group and the optic nerve injury group were siginificantly different from the intracranial combined injury group, respectively(P<0.008 3), and the frequency of abnormal reduction of VEP amplitude of threshold were significantly different from the central nervous system injury group, respectively(P<0.008 3).@*CONCLUSIONS@#VEP can distinguish central injury from peripheral injury, eyeball injury from nerve injury in peripheral injury, but cannot distinguish simple intracranial injury from complex injury, which provides basic data and basis for further research on the location of visual impairment injury.

Major trauma and severe burn: a synergistic mortality: case report and literature review / Traumatismo grave y quemadura severa: una mortalidad sinérgica: reporte de un caso y revisión bibliográfica

CASE PRESENTATION: A 42-year-old man was transferred to our institution after a highenergy accident (an explosion). He presented second-degree burns on 20% of the total body surface area (TBSA), affecting the lower hemiabdomen and the lower right limb. He also presented a supraintercondylar open fracture of the right femur (Gustilo I). The burns were treated with debridement and coverage withmesh graft, while the fracture required an early transitory transarticular external fixation with delayed definitive osteosynthesis. Our patient presented good local and systemic evolution. We can offer a eleven-month follow-up. DISCUSSION: The literature supports that the combination of trauma and burn injuries is a relatively rare pattern, which may explain the lack of knowledge and studies on this subject. This double injury has demonstrated a synergistic effect on mortality. The management of soft tissues in the coexistence of an open fracture and a burn in the same limb is a challenge. The method and timing of the treatment of the fracture directly impacts the treatment of the burn (and vice versa), and most authors tend to treat the fracture first. All of the studies reviewed emphasized the importance of the multidisciplinary approach. CONCLUSIONS: We have presented a complex case combining major trauma and severe burns. Although there is a lack of studies in the literature on this subject, the papers state that this is an unusual pattern with a synergistic effect on mortality. In our experience, the management of soft tissues and the multidisciplinary approach play a central role, as it is also stated in the literature. The management of these patients is still controversial, and more studies are needed.

PRESENTACIÓN DEL CASO: Hombre de 42 años trasladado a nuestra institución tras un accidente de alta energía (explosión). Presentaba quemaduras de segundo grado del 20% de la superficie corporal total (SCT), afectando el hemiabdomen inferior y la extremidad inferior derecha. También presentaba una fractura abierta supraintercondílea de fémur derecho (Gustilo I). Las quemaduras fueron tratadas mediante desbridamiento y cobertura mediante injerto mallado, mientras que la fractura requirió un fijador externo transarticular precoz de forma transitoria con una osteosíntesis definitiva diferida. Nuestro paciente presentó buena evolución local y sistémica. Podemos ofrecer un seguimiento a 11 meses. DISCUSIÓN: La bibliografía defiende que la lesión combinada de traumatismo y quemadura es un patrón relativamente raro, pudiendo explicar la falta de conocimiento y publicaciones al respecto. Este doble insulto ha demostrado un efecto sinérgico en la mortalidad. El manejo de las partes blandas cuando coexisten una fractura abierta y una quemadura en la misma extremidad es un desafío. El método y el momento de tratamiento de la fractura impactan de forma directa en el tratamiento de la quemadura (y viceversa); y la mayoría de los autores tienden a tratar en primer lugar la fractura. Todos los estudios analizados enfatizan la importancia del abordaje multidisciplinario. CONCLUSIONES: Hemos presentado un caso complejo combinando traumatismo grave y quemaduras severas. Aunque haya una falta de bibliografía, los estudios afirman que se trata de un patrón inusual con un efecto sinérgico sobre la mortalidad. En nuestra experiencia, el manejo de las partes blandas y el abordaje multidisciplinario tienen un rol central, tal y como defienden también los artículos publicados. El manejo de estos pacientes sigue siendo controvertido, y son necesarios más estudios.

Research progress of surgical treatment for anterior shoulder dislocation and combined injuries / 中国修复重建外科杂志

Objective: To summarize the research progress of surgical treatment for anterior shoulder dislocation and combined injuries. Methods: The related literature was reviewed, and the surgical treatment options for the anterior shoulder dislocation and its combined injuries were summarized. Results: Anterior shoulder dislocation can combine with anteroinferior capsular ligament complex injury (Bankart injury), bony Bankart defect, and Hill-Sachs lesion. For Bankart and bony Bankart injuries, arthroscopic repair or coracoid osteotomy combined with bony graft reconstruction can be performed. For Hill-Sachs lesion, conservative treatment, soft tissue repair, or bony reconstruction should be selected based on the extent of the bone defect. For bipolar injury, the Bankart repair, Remplissage, or arthroplasty should be selected based on the extent of the glenoid defect. Conclusion: With the development of arthroscopy and the improvement of the surgical concept, there is a complete set of surgical options for various injuries of the anterior shoulder dislocation. When choosing a surgical procedure, the patient's specific injury and age, exercise level, and other relating factors should be comprehensively assessed in order to achieve the best results.

Application of Arthroscopy in the Treatment of Chronic Ankle Instability / 中国微创外科杂志

[Summary] Ankle joint injury is one of the most common sports injuries , and some patients with chronic ankle instability need surgical treatment .Traditional incision surgeries are characterized with traumatic performance and high complication rates , and the exploration of the joint lesion is not comprehensive .With the development of minimally invasive surgery , the application of arthroscopy in the treatment of chronic ankle instability is increasing , which is conducive to the treatment of intra-articular lesions , while reducing the surgical trauma and improving the postoperative effects .In this paper , we summarized the current status of the application of arthroscopy in the surgery for chronic ankle instability from two aspects , which were arthroscopic surgery in the diagnosis and treatment of the disease, and total arthroscopic repair technology of ankle ligament .We also introduced domestic and overseas operation effects and new concepts .

Rescue, allocation and nursing of multiple- patient burn- blast combined injury in Kunshan explosive accident / 中国实用护理杂志

Objective To discuss on nursing of patients multiple- patient burn- blast combined injury, the cooperation of processes and quality control. Methods For 35 cases of burn- blast combined injury, emergency plan was initiated immediately, including staffing allocation, supplies allocation, nursing quality control and monitoring the inpatient areas, etc. Results 35 cases of burn- blast combined injury acquired immediate treatment of burn shock and nursing. Rescue rate of multiple- patient burn blast arrived 77.14%(27/35), with no case of nursing complication. Conclusions Timely allocation of nursing staff, rational quantity and structure, forceful organization and coordination, complete and timely supplies, correct quality control of emergence nursing and beneficial solutions are keys to ensure successive nursing of intensive patients of burn-blast combined injury, and also reflection of nursing quality guarantee.

Comparison of Early and Delayed Reconstruction of the ACL in Combined Injuries of the ACL and MCL of the Knee

PURPOSE: The aim of this study was to compare the results between early and delayed reconstruction of the anterior cruciate ligament (ACL) in patients with combined medial collateral ligament (MCL) injuries. MATERIALS AND METHODS: From February 2001 to January 2007, fifty-five patients who had undergone ACL reconstruction for combined ACL and MCL injuries and who were followed for more than 18 months were included in this study. The Tegner Activity Score, the Lysholm Knee Scoring Scale, the interval to recover 90degrees of motion, the Lachman test, the anterior and valgus laxity noted on stress radiograph, and the International Knee Documentation Committee (IKDC, 1993) documentation were recorded and compared between the early reconstruction group, which underwent ACL reconstruction within 3 weeks, and the delayed reconstruction group, which underwent ACL reconstruction after 3 weeks. RESULTS: At the final follow up, the Tegner score was 7.4 in the early reconstruction group and 7.6 in the delayed reconstruction group. The Lysholom score was 90.5 and 91.3, respectively (p>0.05). All the cases were rated near normal or normal on the IKDC subjective assessment. The early reconstruction group needed a longer time to recover motion and especially in the female patients. However, there was no statistical difference between the groups for the final range of motion, in addition to the Lachman test and the anterior or valgus laxity. CONCLUSION: In this study, satisfactory clinical and radiological results were obtained in both the early and delayed reconstruction groups. The early reconstruction of the ACL seems to be one of the surgical options for reconstruction of acute ACL injury combined with torn MCL.

CXCR4 gene transfection enhancing the distribution of dMSCs to the wounded skin of rats with combined wound and irradiation injury / 中华放射医学与防护杂志

Objective To observe whether the transplanted dermal multipotent stem cells(dMSCs)transfected by adenovirus vector of CXCR4(Adv-CXCR4)can distribute more frequently to the wound of rats with combined wound and irradiation injury.Methods dMSCs transfected by Adv-CXCR4(group A),or transfected by adenovirus vector of green fluorescent protein(group B),and non-transfected dMSCs were labeled with 3H-TdR and then transplanted into combine-injured rats.The amount of dMSCs in wound were determined by liquid scintillation,and wounds healing process was observed by measuring the remaining wound area.Results From the 5th day after transplantation,the amount of dMSCs in the wound of group A accounted for 1.95%-3.85% of the total transplanted dMSCs,significantly greater than those in group B and group C,which accounted for 1.07%-1.86% of the total transplanted dMSCs.The remaining wound area in group A was smaller than those in group B and group C from day 12 after injury,and the healing time of group A was 1.5 day ahead than group B and group C.Conclusions dMSCs transfected by Adv-CXCR4 distributes more frequently to the wound of combine-injured rats and could accelerate wound healing.

Treatment of burn complicated fracture / 国际外科学杂志

Objective To analyze the treatment principles of burn patients with fractures and the clinical application of external fixation.Methods The treatment methods and efficacy in 48 patients with bum complicated fracture were summarized.Limb fractures were 53,femoral shaft 21,tibia and fibula 28,humerus 13,ulnar bone torsion 5.Closed 44,open 23.All limbs received external fixation,with single-arm multifunctional external fixator in 47,bilateral 17,Monteggia 3.Burn wound dressing was dealed with the situation in accordance with surgical debfidement or skin flap.Results The 48 cases were found no deaths,and 67 fractures healed and discharged healing time 2.5～5 months,3.1 months on average.Limb and joint function showed a good recovery.Conclusions External fixation showed fixation stability,simple operation,mild tissue injury,easy handling and anti-burn scar contracture and other advantages.Clinical results were satisfactory.

The changes of pulmonary surfactant assodated protein A in BALF with lung injury in rats with blast injury and blast injury combined with hypmia / 中华急诊医学杂志

Objective To investigate the changes of surfactant associated protein A (ST-A) concentration inBALF and its relatiomhips with pulmonary injury after blast injury and blast injury combined with hypoxia. MethodTotally 131 Wistar rats (purchased from animal center of research Institute of Surgery, Daping Hospital, ThirdMilitary Medical University) were randomly divided into four groups: blast injury group ( BI group), blast injurycombined with hypoxia group Ⅰ (BAg Ⅰ group), blast injury combined with hypoxia group Ⅱ (BA Ⅱ group) andnormal control group. After blast injury was made by KST - Ⅰ bio-shock tube, rats of BA Ⅰ and BA Ⅱ groups wereput into hypoxia cabins immediately, where gas mixtures of 12.5% and 10.0% oxygeon were given, respectively.Rats were sacrificed at 1, 3 and 6 hours after injury for gross anatomic examination, light and electron microscopeobservation and lung water determination. The level of SP-A in BALF was detected by Western blot. The data wereprocessed by t test or Chi-square test. Results The respiration increased with shortness of breath and dysphoria inrats of BA Ⅰ and BA Ⅱ groups, and obvious cyanosis on the lips and nose in rats of BA Ⅱ group after blast injury.The lung water in rats of all injury groups was significantly higher than that in normal control group (P<0.05).Gross anatomy changes were mainly pulmonary bleeding and edema. Under light microscope, incrassation of alveo-lar wall, bleeding in alveolar and mesenchyme edema were found. Whereas under electron microscope, breakageof alveolar wall and decrease of lamellar bodies in type Ⅱ cell were observed. All these changes were most obviousin BA Ⅱ group followed by BA Ⅰ and BI groups in severity decling order, with mortality rate of 37.5%, 11.1%and 2.1% respectively at 6 hours (P<0.01). The SP-A level in BALF decreased significantly (P<0.01) andhad a good negative relationship with the lung water after injury (r=0.796, P<0.001 ). Conclusions Blastinjury combined with hypoxia significantly deteriorates the lung injury. More severe and longer hypoxia may resultin more severe lung injury and higher mortality rate. A decrease in SP-A value in BALF shows a good negative re-lationship with the pulmonary edema. The SP-A can be a good indicator for lung injury severity after blast injuryand blast injury combined with hypoxia.

An experimental investigation of the effect of seawater immersion on endothelial cells in dogs sustained by burn-firearm combined injury / 第三军医大学学报

Objective To study the influence and mechanism of seawater immersion on endothelial cell injury sustained by burn firearm combined injury to improve the early therapeutic efficacy. Methods The dogs with burn firearm combined injury were randomly divided into two groups: immersion group and control group. In immersion group, the dogs were immersed in seawater for 4 hours, then taken out from seawater. Blood samples were collected from central vein at 4 h, 7 h, 10 h, 20 h and 28 h following wound for the detection of changes of the circulating endothelial cells (CEC) and von Willebrand Factor (vWF). The same procedures except immersion were performed in the control group. Results The levels of CEC and vWF elevated at 4 h and 7 h following wound in control group( P

Effect of OFR on small intestinal injury in rats exposed to sulfur mustard and burn / 第三军医大学学报

Objective To investigate the effect of oxygen free radical (OFR) on the injury of small intestine in rats treated with burn, sulfur mustard or sulfur mustard plus burn. Methods Totally 95 SD rats were randomly divided into four groups: 30 rats subjected to 30 third-degree TBSA scalding (B), 30 injected subcutaneously with 2 ml/kg sulfur mustard (S), 30 subjected to both (SB), 5 as normal controls (C). Activity of diamine oxidase (DAO) and superoxide dismutases (SODs), contents of malonaldehyde (MDA) in plasma, and pathological changes of ileum at 2, 6, 12, 24, 48, 72 h after injury were observed. Results Three treatments could induce significant decrease of activity of SODs (P

Anterior Cruciate Ligament Reconstruction Using a Contralateral Hamstring Tendon Graft in Combined Anterior Cruciate and Medial Collateral Ligament Injury / 대한정형외과학회잡지

PURPOSE: We reviewed the results of a series of patients with combined anterior cruciate ligament and medial collateral ligament injury who received nonoperative management of medial collateral ligament with anterior cruciate ligament reconstruction using a contralateral hamstring tendon graft. MATERIALS AND METHODS: From May 2000 to June 2001, 12 cases (20-46 years; mean, 35 years) were available for follow-up (12-23months; mean, 16.7 months) with combined anterior cruciate ligament and medial collateral ligament injury that underwent anterior cruciate ligament reconstruction alone using a contralateral hamstring tendon graft. Follow-up evaluation involved; KT-2000 arthrometer testing, valgus stress testing and the International Knee Documentation Committee (IKDC) evaluation form. RESULTS: Mean side to side difference of manual maximum anterior displacement using the KT-2000 arthrometer was 1.75 mm. All cases showed a firm end point by the valgus stress test. At the final IKDC evaluation, 2 cases were graded as normal, 8 nearly normal, 1 abnormal and 1 severely abnormal. The donor site result of the IKDC evaluation form showed normal in 8, nearly normal in 3 and abnormal in 1. CONCLUSION: These results demonstrate the effectiveness of ACL reconstruction alone using the contralateral hamstring tendon graft as an autograft in combined ACL and MCL injury, which was found to restore satisfactory stability with minimal complications at both injured and donor sites.

Management of Acute Combined Injuries of the Medial Supporting Structures and Anterior Cruciate Ligament of the Knee

PURPOSE: We introduce the management protocol of medial structures-ACL combined injury patients in Asan Medical Center and evaluate the results of the management according to severity of medial injuries. MATERIALS AND METHODS: From Jan.1994 to May 1998, we treated 30 cases of acute combined injuries of medial structures and ACL. Unless the medial structures shows grade IIIwithout end point, we man-aged the medial structures conservatively and conducted ACL reconstuction . After that, we analysed the results of the management. Evaluation was based on the Lysholm knee scoring system, physical examina-tion and stress radiographs. RESULTS: The functional result by Lysholm knee scoring revealed 92.4/95.3(medial structures conserva-tive / repair groups) respectively. Except 1 case of persistent medial laxity in medial structures repair group, there was no severe complication in both groups. CONCLUSIONS: There was no significant medial laxity after conservative management in grade I,II,III with end point injury of medial supporting structures and we had good results in severe medial injury involving MCL, posterior oblique ligament in terms of ROM and stability with open repair of medial structures and delayed arthroscopic ACL reconstruction.

The MRI Findings and Clinical Analysis in the Severe Diffuse Axonal Injury

The distribution and extent of traumatic lesions were evaluated with MRI in 31 patients with diffuse axonal injuries(DAI). Authors also analyzed patients with diffuse axonal injury, clinically. The patients with DAI showed statistically significant lower incidence of lucid interval, fracture of the skull and intracranial hematoma. Combined injuries, intracrnial hematomas and distribution of lesions were proved to be poor prognostic factors of DAI. Diffuse axonal injury is most commonly involved in the white matter of the frontal and temporal lobes and the splenium of the corpus callosum. Patients with lesions in brainstem and cerebellum revealed worst prognosis. In our studies, the sensitivities of the imaging techniques for diffuse axonal injuries were 7.3% with CT scan, 75.6% with T1WI, and with 97.6% in T2WI of MRI, respectively. The authors concluded that MRI has clear advantages over CT in evaluating diffuse axonal injuries.

Role of Pulmonary Alveolar Macrophage in Lung Injury after Burn—Blast Combined Injury / 中华创伤杂志

In order to clarify the relationship between PAMs and post—trauma lung injury, the H_2O_2 produced by PAMs and catalase activity of bronchoalveolar lavage fluid (BALF) and lung homogenate were measured at hours 6、12、24、48 and 72 after burn、blast injury and burn—blast combined injury in 128 rats, respectively. After trauma, H_2O_2 produced by PAMs was increased compared with PAMs from control lungs, especially in the combined injury groups. The catalase activity of BALF and lung homogenate decreased. The catalase activity in combined injured lungs was the lowest. The results indicated 1. the activation of PAMs might play a role in post—trauma lung injury: 2. the damage of pulmonary antioxidant system after trauma may enhanced the lung injury; 3. the state of PAMs activation and the damage of pulmonary antioxidant system were related to the severity of trauma.

Serum from rat exposed to radiation,burn,or combined injury can stimulate the PI3K/Akt pathway of IEC-6 cells / 第三军医大学学报

Objective To explore the activation of PI3k/Akt pathway of serum deprived IEC-6 cells by the serum of rats exposed to single radiation,burn or combined injury.Methods The IEC-6 cells were cultured in serum deprived media for 24 h,and stimulated by the serum of rats exposed to single radiation(~(60)Co ? ray at dose of 9 Gy),single burn(exposure to 5 kW tungsten-halogen light till whole body Ⅲ degree burn) or combined injury(burn first and radiation),and the cells stimulated by the serum from the normal rats and serum starved cells served as the control group.The total proteins of different group cells were extracted and the levels of phosphorylation of Akt were tested by Western blotting.The differentially expressed low mass proteins in the serums were detected by SELDI proteinchip technology,and primarily analyzed by related software as well as bioinformatic methods.Results The level of phosphorylation of Akt in the IEC-6 cells stimulated by serum from rats exposed to single radiation,single burn or combined injury was higher than in the cells stimulated by the serum from normal rats,in which the burn serum caused the highest level.As compared to burn rat serum,the serum of radiation and combined injury had 13 and 6 differentially expressed protein peaks respectively.Conclusion All the serums from rats exposed to different kinds of damage agents could activate the PI3K/Akt pathway of IEC-6 cells efficiently.The special components of burnt rat serum may contribute to the highest effect on the phosphorylation of Akt.

Experimental Study on DMAP used in the Combined Injury of Acute Hemorrhage and Cyanide Intoxication in Dogs / 第三军医大学学报

The animal models of the combined injuries of mild, medium or severe hemorrhage and cyanide intoxication were produced by bleeding to 9.33, 6.67, or 5.33 kPa of arterial systolic pressure and administrating NaCN 2.5 mg/kg intravenously. Dogs with the combined injury of acute mild hemorrhage and cyanide intoxication in control group did not receive DMAP treatment whereas dogs in DMAP treatment groups receiveed DMAP 2 mg/kg iv at 3 min after administrating cyanide. The changes of hemodynamics and blood gases and methemoglobin were determined. The dogs receiving no DMAP treatnent in control group died within 5 min after intoxication. DMAP has an excitatory effect on hemodynamics after giving to dogs with the combined injury of acute mild hemorrhage and cyanide intoxication. It can save the dogs from death. The excitatory effect of DMAP on hemodynamics becomes weaker while the level of acute hemorrhage increases. The results of blood gas and methemoglobin analysis indicated that DMAP can disturb the oxygen-carrying capacity of hemoglobin because of the formation of much higher concentration of methemoglobin when DMAP is used as an antidote for the combined injury of acute hemorrhage and cyanide intoxication. The results suggested that methemoglobin formers should not be used as the antidotes for the combined injury of acute hemorrhage and cyanide intoxication.