Factor tiempo en la atención inicial del paciente politraumatizado / Factor time in the initial attention of the poly-traumatized patient

RESUMEN Introducción: el politraumatismo por si solo constituye uno de los problemas más grandes de la sociedad moderna. Las lesiones traumáticas en Cuba aparecen en el quinto lugar entre las causas globales de muerte para todas las edades. Objetivo: determinar cómo incidió el factor tiempo en la organización de las acciones para la atención de urgencia al paciente politraumatizado. Materiales y método: se realizó un estudio observacional, conformado por 183 pacientes politraumatizados, atendidos en la Unidad de Cuidados Intensivos Emergentes del Hospital Provincial". José R. López Tabrane " de Matanzas, durante el año 2014. Las variables a considerar fueron: edad, sexo, tiempo en que recibieron las primeras acciones, tiempo de llegada al Hospital, factores asociados que influyeron en la aparición de injuria secundaria. Se utilizó la técnica estadística de análisis de distribución de frecuencias. Resultados: el mayor porcentaje de los pacientes (82,6 %) acudieron 4-6 h después de sufrido el traumatismo. Aparecieron factores como la hipotensión, la hipoxia (66,1 y 50,2 %) respectivamente, que tuvieron lesiones asociadas y fueron valoradas en la primera hora del traumatismo. Conclusiones: el trauma severo es una de las entidades prevenibles que más vida cobra en la sociedad. El sexo masculino y edades más productivas de la vida fueron los que más morbimortalidad presentaron. El hecho de que la mayor cantidad de estos pacientes arribaron al Hospital después de la hora dorada, propició un mayor número de complicaciones por el no control a tiempo de los elementos que forman la injuria secundaria (AU).

ABSTRACT Introduction: polytrauma, by itself, is one of the biggest problems of the modern society. Trauma lesions in Cuba are in the fifth place among the death global causes for all age groups. Objective: to determine how time factor had an impact in the actions organization for the emergency care to polytrauma patient. Materials and method: an observational study was performed in 183 poly-trauma patients who attended the Intensive Care Unit of the Provincial Hospital "Jose Ramón López Tabrane" of Matanzas during 2014. The considered variables were: age; sex; time of receiving the first actions; time of arrival to the hospital; associated factors influencing in the appearance of secondary injury. The authors used the statistic technique of analysis of frequency distribution. Results: the highest percent of patients (82.6 %) assisted the consultation 4-6 hours after suffering the trauma. There were found factors like hypotension and hypoxia (66.1 and 50.2 % respectively that had associated lesions and were assessed in the first hour of the trauma. Conclusions: acute trauma is one of the preventable entities taking more lives in the society. Male sex predominated and the more productive ages of life were the ones presenting more morbid-mortality. The fact that the biggest quantity of these patients arrived to the hospital after the golden hour favored a higher number of complications due to the untimely control of the elements forming the secondary injury (AU).

Effect of Minocycline on Acute Closed Spinal Cord Injury in Rats / 中国康复理论与实践

Objective:To investigate the neuroprotective effect of minocycline on the secondary injury after acute closed spinal cord injury in rats. Methods:A total of 24 Sprague-Dawley male rats were randomly divided into saline group (n = 8), magnesium chloride group (n = 8) and minocycline group (n = 8). The closed spinal cord injury model was prepared with balloon compression in the dorsal spinal cord of rat, which was evaluated with magnetic resonance imaging. All rats were successively administered their own drugs for seven days after injury, respectively. They were assessed with BBB score two to 31 days after operation. Their motor-evoked potential and sensory-evoked potential were detected 31 days after operation, and then Luxol Fast Blue was used to observe the area of secondary injury. Results:Animal magnetic resonance imaging showed hypointense in T2 images in T10 spinal cord. BBB score was more in the minocycline group than in the saline group since 17 days after operation (P < 0.05). The amplitude of motor-evoked potential was higher in the minocycline group than in the saline group (P < 0.05), while the area of secondary injury was less (P < 0.05). Conclusion:Minocycline may protect the nerves from secondary injury after acute spinal cord injury.

Potential immunotherapies for traumatic brain and spinal cord injury / 中华创伤杂志(英文版)

Traumatic injury of the central nervous system (CNS) including brain and spinal cord remains a leading cause of morbidity and disability in the world. Delineating the mechanisms underlying the secondary and persistent injury versus the primary and transient injury has been drawing extensive attention for study during the past few decades. The sterile neuroinflammation during the secondary phase of injury has been frequently identified substrate underlying CNS injury, but as of now, no conclusive studies have determined whether this is a beneficial or detrimental role in the context of repair. Recent pioneering studies have demonstrated the key roles for the innate and adaptive immune responses in regulating sterile neuroinflammation and CNS repair. Some promising immunotherapeutic strategies have been recently developed for the treatment of CNS injury. This review updates the recent progress on elucidating the roles of the innate and adaptive immune responses in the context of CNS injury, the development and characterization of potential immunotherapeutics, as well as outstanding questions in this field.

Low-Level Laser Irradiation Improves Motor Recovery After Contusive Spinal Cord Injury in Rats

This study investigated the therapeutic effects of low-level laser irradiation (LLLI) on the recovery of motor function and its underlying mechanisms in rats with spinal cord injury (SCI). The spinal cord was contused at the T11 level using a New York University impactor. Thirty-eight rats were randomly divided into four groups: LLLI with 0.08 J, 0.4 J, 0.8 J, and sham. We transcutaneously applied at the lesion site of the spinal contusive rats 5 min after injury and then daily for 21 days. The Basso, Beattie and Bresnahan (BBB) locomotor scale and combined behavioral score (CBS) were used to evaluate motor function. The spinal segments of rostral and caudal from the lesion site, the epicenter, and L4–5 were collected from normal and the all groups at 7 days after SCI. The expression of tumor necrosis factor-α (TNF-α) and inducible nitric oxide synthase (iNOS) was compared across groups in all regions. In the present study, LLLI with 0.4 J and 0.8 J led to a significant improvement in motor function compared to sham LLLI, which significantly decreased TNF-α expression at the lesion epicenter and reduced iNOS expression in the caudal segment for all LLLI groups and in the L4–5 segments for the 0.4 J and 0.8 J groups when compared to sham LLLI group. Our results demonstrate that transcutaneous LLLI modulate inflammatory mediators to enhance motor function recovery after SCI. Thus, LLLI in acute phase after SCI might have therapeutic potential for neuroprotection and restoration of motor function following SCI.

Secondary Injury and Treatment of Adductor Spasticity in Children with Cerebral Palsy (review) / 中国康复理论与实践

@#The adductor spasticity is a common symptom in children with cerebral palsy. The ultramicrostructure damages have been found in adductor. If the spasticity is not treated in time, there will be some secondary injury, such as hip joint dislocation, muscle tendon crispation, contracture of joint, hip pain, and so on. The treatment for adductor spasticity includes stretching, orthosis, training device, selective posterior rhizotomy, neurotomy of anterior branch of obturator nerve, Adductor myotomy, phenol block, Botulinum Toxin injection, Intrathecal baclofen etc. Every method has its own advantage and disadvantage.

Bilateral cortical atrophy after severe brain trauma and extradural homatoma

We report the case of a severe head injured 43-year old male patient with a large extradural hematoma, Glasgow Coma Scale 3 and dilated fixed pupils. Patient was promptly submitted to surgical evacuation of the lesion, but remained in persistent vegetative state in the post-operative time. Head computed tomography scans performed before surgery, and at early and late post-operative periods comparatively revealed extreme bilateral cortical atrophy. Late consequences of severe head trauma drastically affect the prognosis of patients, being its prevention, and neuroprotection against secondary injury still a therapeutical challenge for neurosurgeons.

Relatamos o caso de um paciente de 43 anos, com traumatismo cranioencefálico grave, com grande hematoma extradural, Escala de Coma de Glasgow 3 e pupilas fixas e dilatadas. O paciente foi prontamente submetido à evacuação cirúrgica da lesão mas permaneceu em estado vegetativo persistente no período pós-operatório. As TC de crânio realizadas antes da cirurgia e nos períodos pós-operatórios precoce e tardio revelaram comparativamente extrema atrofia cerebral bilateral. As conseqüências tardias do traumatismo craniano grave afetam drasticamente o prognóstico dos pacientes, sendo sua prevenção, e a neuroproteção contra a injúria secundária ainda um desafio terapêutico para os neurocirurgiões.

Secondary Injury to the Perihematoma Region of Intracerebral Hemorrhage / 国际脑血管病杂志

The changes of pathophysiology of perihematomal tissue after intracerebral hemor- rhage are extremely complicated.Studies in recent years have suggested that perihematomal tissue does exist many changes of pathophysiology and molecular biology,such as mass effect of hematoma,hematoma components damage to perihematomal tissue,hemodynamic changes, neuropeptide Y and matrix metalloproteinase changes,etc.

Cell Death in Acute Spinal Cord Injury

OBJECTIVE: In acute spinal cord injury, biomechanical and pathological changes in the cord may worsen after injury. To explain these phenomena, the concept of the secondary injury has evolved and numerous pathophysiological mechanisms have postulated. These, however, have mainly focused only on the cell necrosis. The aim of present study is to verify whether apoptosis plays a role in the animal model of secondary injury of spinal cord. MATERIALS AND METHODS: Adult male Sprague-Dawley rats were laminectomized and spinal cord injury was induced using NYU spinal impactor at T9 segment. The animals were sacrificed periodically and tissue specimen was obtained at the injury segment, adjacent segments, and remote segments to observe the secondary injury ultimately for the observation of the spatial and temporal distribution and the related cells for the appearance of apoptosis, if present. RESULTS: In the spatial distribution of apoptosis, the apoptotic cells were located at gray matter of spinal cord and the number of apoptotic cells were significantly higher in adjacent segments than in the injured segment. In the temporal distribution of apoptosis, the number of apoptotic cells were maximal at 4 hours after injury and decreased subsequently. No apoptotic cells were found at remote segments which implies that there were no influence of apoptosis on transneuronal degeneration. CONCLUSION: These results suggest that the lesioned area of spinal cord expanded over time in acute spinal cord injury and apoptosis contributed to the spinal cord neuronal and glial cell loss. In conclusion, apoptosis is thought to have an important role in secondary injury of acute spinal cord injury.

Teaching Medical Students About Sexual Harassment with a Role Play Method / 医学教育

As part of an occupational health curriculum, 3rd-year medical students were taught about sexual harassment so that they can treat victims in an appropriate way. A lecture presented basic information: the definition of sexual harassment, its history, legal aspects, specific features, effects on victims' physical and psychological health, and appropriate approaches of doctors to victims. Students then played roles of both a patient and an occupational health doctor. A patient profile was created on the basis of a legal case.<BR>Students were extremely interested in the course and judged it highly. Role play helped students develop a sincere interest in the problem of sexual harassment and an empathic understanding of its victims. The relevance of sexual harassment to medical education is discussed.

The relationship between cell apoptosis and Phospho-Ser~(727) Stat1 expression in the rat with experimental diffuse axonal injury / 中国法医学杂志

Objective To investigate the role of Stat1 in pathological process of nerve cells apoptosis induced by diffuse axonal injury (DAI) on rats. MethodsThe DAI model was established by using an injury model adapted from Marmarou et al. in 1994. All animals were divided into three groups, including control group, mock group and test group sacrificed on 6, 12, 24, 48, 72, 120 and 240 hours post injury (hpi). The paraffin-embedded sections of brain tissue were processed for HE staining and Bielschowsky’s silver method. Cell apoptosis was examined by flow cytometry and the expression of bax and bcl-2 were analyzed by RT-PCR. And Phospho-Ser727 Stat1 expression was examined by immunohistochemistry in different brain regions. ResultsThere was no brain contusion within HE staining, however, waving and enlargement of axons were observed within Bielschowsky’s silver method. The apoptotic rate of brain cells as well as PCR products ratio of bax to bcl-2 was highest at 24 hpi and decreased with time. An up-regulation of Phospho-Ser727 Stat1 at 6 hpi was discernible, and then reached the top at 24 hpi in cortex, cerebellum, brain stem and corpus callosum, and at 12 hpi in hippocampus. This increase was associated with the nerve cells apoptosis, r=0.921. In addition, the Phospho-Ser727 Stat1 positive cells were neurons and glial cells assessed from morphous. ConclusionsOur data indicate that Stat1 may contribute to the apoptosis of DAI on rats. In addition, the expression of Phospho-Ser727 Stat1 in glial cells suggested that glial cells may play an important role in the pathogenic mechanism of DAI.