Penetrating Stab Wounds of the Spine: Two Cases and Review of the Literature

Penetrating wounds of the spine caused by edged weapons are on the increase due to the growing insecurity, violence, availability and accessibility of these weapons, which are generally objects of everyday use (knife, axe, machete, screwdriver, bicycle spoke, scissors, garden fork, sickle and sharpened broom handle, etc.). These objects may be the cause of penetrating wounds responsible for neurological deficits with breaches of the dura mater, or they may be without neurological deficits due to the level of the weapon in the spine. We present two clinical cases of patients with penetrating knife wounds of the spine. One at cervical level with pneumorrhagic emphysema, spinal cord compression and pneunemoencephaly, with neurological deficit who had a surgicalintervention followed by physiotherapy and a progressive recovery, the other with a penetrating wound at L5 crossing the blade to the vertebral body without neurological deficit in whom the knife was extracted at the emergency department without secondarydeficit. Penetrating wounds of the spine are caused by stab wounds, including knives. In particular, emphysema, diffuse pneumorrhagia and pneumoencephalus are extremely rare in the same patient, this being due to the knife extraction technique. These lesions, associated with neurological deficit and cerebrospinal fluid (CSF) leakage, constitute a neurosurgical emergency.

A Pilot Study to Evaluate the Effects of Cerebroprotein Hydrolysate on Neurological Outcomes and Hospital Stay in Patients Admitted for Ischemic and Hemorrhagic Stroke

Introduction: Neurological stroke is the most common cause of disability and leaves nearly 65% of survivors with sensory, motor and coordinative disabilities. At present, there are no therapies to prevent long-term neurological deficits after stroke. Many neuroprotective drugs are being tested with the aim to ensure these effects. Preclinical studies have shown a modulatory effect of cerebroprotein hydrolysate on synaptic remodeling and facilitated synaptic transmission. Material and methods: This was a hospital-based, open-label pilot study conducted in a tertiary care hospital of North India. All patients admitted with a diagnosis of stroke both ischemic and hemorrhagic, were included in the study. Patients were randomized into two groups. The test group was given cerebroprotein hydrolysate, along with standard treatment for stroke, whereas the other group was kept on standard treatment for stroke as per the latest guidelines, without cerebroprotein. Results: A total of 50 patients of stroke, admitted in a tertiary care center were included in the study. The mean age of the patients was 65.7 ± 11.86 years. Twenty-six (52%) were males and 24 (48%) were females. Out of the total 50 patients, 23 (46%) had ischemic stroke and 27 (54%) had hemorrhagic stroke. Twenty (40%) had diabetes, 37 (74%) had hypertension, 8 (16%) were known cases of coronary artery disease, 28 (56%) had dyslipidemia, 22 (44%) were smokers, 7 (14%) had a history of ethanol consumption and 13 (26%) were obese. Mean Barthel score at admission was 21.2 ± 11.3 and mean Rankin score at admission was 3.6 ± 1.37. Mean Barthel score at end of treatment was 53.9 ± 28.72 and mean Rankin score at end of treatment was 2.6 ± 1.65. The mean duration of admission was 6.8 ± 3.57 days. Conclusion: The current study highlights the role of cerebroprotein hydrolysate in improving the neurological scores and reducing hospital stay among patients hospitalized with stroke.

A Pilot Study to Evaluate the Effects of Cerebroprotein Hydrolysate on Neurological Outcomes and Hospital Stay in Patients Admitted for Ischemic and Hemorrhagic Stroke

Introduction: Neurological stroke is the most common cause of disability and leaves nearly 65% of survivors with sensory, motor and coordinative disabilities. At present, there are no therapies to prevent long-term neurological deficits after stroke. Many neuroprotective drugs are being tested with the aim to ensure these effects. Preclinical studies have shown a modulatory effect of cerebroprotein hydrolysate on synaptic remodeling and facilitated synaptic transmission. Material and methods: This was a hospital-based, open-label pilot study conducted in a tertiary care hospital of North India. All patients admitted with a diagnosis of stroke both ischemic and hemorrhagic, were included in the study. Patients were randomized into two groups. The test group was given cerebroprotein hydrolysate, along with standard treatment for stroke, whereas the other group was kept on standard treatment for stroke as per the latest guidelines, without cerebroprotein. Results: A total of 50 patients of stroke, admitted in a tertiary care center were included in the study. The mean age of the patients was 65.7 ± 11.86 years. Twenty-six (52%) were males and 24 (48%) were females. Out of the total 50 patients, 23 (46%) had ischemic stroke and 27 (54%) had hemorrhagic stroke. Twenty (40%) had diabetes, 37 (74%) had hypertension, 8 (16%) were known cases of coronary artery disease, 28 (56%) had dyslipidemia, 22 (44%) were smokers, 7 (14%) had a history of ethanol consumption and 13 (26%) were obese. Mean Barthel score at admission was 21.2 ± 11.3 and mean Rankin score at admission was 3.6 ± 1.37. Mean Barthel score at end of treatment was 53.9 ± 28.72 and mean Rankin score at end of treatment was 2.6 ± 1.65. The mean duration of admission was 6.8 ± 3.57 days. Conclusion: The current study highlights the role of cerebroprotein hydrolysate in improving the neurological scores and reducing hospital stay among patients hospitalized with stroke.

Diagnóstico de SCIWORA asociado a síndrome de Brown Séquard en un adolescente / Diagnosis of SCIWORA associated with Brown Séquard syndrome in an adolescent

Resumen: El término SCIWORA (Spinal Cord Injury Without Radiologic Abnormality) describe una patología poco frecuente que afecta principalmente a pacientes pediátricos. Presentamos el caso de un paciente adolescente diagnosticado con SCIWORA/síndrome de Brown Séquard, el cual presenta múltiples contusiones en cuello y hemicuerpo derecho, de manera inmediata refiere parestesias en las cuatro extremidades y hemiparesia espástica con predominio derecho, incapacidad a la bipedestación y continencia urinaria. Se inicia tratamiento basado en el estudio NASCIS III y posterior a la pruebas de imagen se realizó diagnóstico ya comentado. Exponemos las definiciones más actuales de SCIWORA y las recomendaciones para realizar su diagnóstico así como su relación y coexistencia con síndromes medulares.

Abstract: SCIWORA (Spinal Cord Injury without Radiologic Abnormality) is a rare condition that mainly affects pediatric patients; We present the case of a teenage male patient diagnosed with SCIWORA/Brown Séquard Syndrome. In admission, he has multiple bruises on his neck and right hemibody and immediately he refers paraesthesia in all four limbs and spastic hemiparesis with right predominance, as well as inability to stand up and urinary continence. Treatment based on NASCIS III study is initiated and after the imaging tests, a diagnosis has already been made. We present the most current definitions of SCIWORA and the recommendations to make its diagnosis, as well as its relationship and coexistence with spinal syndromes.

Posterior vertebral column resection (pvcr): a safe and effective option to treat kyphosis from spinal tuberculosis / Ressecção da coluna vertebral por via posterior (rcvp): opção segura e eficaz para tratar cifose por tuberculose vertebral / Resección de la columna vertebral por vía posterior (rcvp): opción segura y eficaz para tratar cifosis por tuberculosis vertebral

ABSTRACT Objective: To evaluate the clinical and radiological results of posterior vertebral column resection (PVCR) for the treatment of kyphosis from spinal tuberculosis. Methods: Retrospective study of a series of 14 cases, 9 female and 5 male, with a mean age of 28 years (1 to 64) at the time of surgery, with spinal tuberculosis with mean kyphosis of 56.42° (2° to 95°). Results: All patients underwent surgical treatment with PVCR, with a mean number of 2.57 (1 to 6) resected vertebrae and a mean number of instrumented vertebrae of 6.14 (4 to 8). The mean kyphosis correction was 64% after up to one year of follow-up. Prior to surgery, eight patients had signs of spinal cord impairment (ASIA score ranging from A to D), and six did not present any deficit of strength or sensory function (ASIA E). There was no neurological worsening and everyone with deficits improved by at least one degree on the scale. In the postoperative follow-up, bone consolidation was observed in all patients, except one. Among the intra- and postoperative complications, pleurotomy was the most prevalent. Conclusion: Posterior vertebral column resection has proven to be a safe and effective option for the treatment of kyphotic deformity from spinal tuberculosis. Level of evidence IV; Therapeutic studies - Investigation of treatment results.

RESUMO Objetivo: Avaliação dos resultados clínicos e radiológicos da ressecção da coluna vertebral por via posterior (RCVP) no tratamento da cifose por tuberculose vertebral. Métodos: Estudo retrospectivo de uma série de 14 casos, sendo 9 do sexo feminino e 5 do sexo masculino, com média de idade de 28 anos (1 a 64) à época da cirurgia, portadores de tuberculose vertebral, com média de cifose de 56,42° (2° a 95°). Resultados: Todos os pacientes foram submetidos ao tratamento cirúrgico com RCVP, com número médio de 2,57 (1 a 6) vértebras ressecadas e número médio de vértebras instrumentadas de 6,14 (4 a 8). A média de correção da cifose foi de 64%, com até um ano de seguimento. Antes da cirurgia, oito pacientes apresentavam sinais de sofrimento medular (escore ASIA variando de A a D) e outros seis não apresentavam déficit de força ou sensibilidade (ASIA E). Não houve piora neurológica, e todos os que tinham déficits melhoraram no mínimo um grau na escala. No seguimento pós-operatório, foi evidenciada consolidação óssea em todos os pacientes, exceto um. Dentre as complicações intra e pós-operatórias, a pleurotomia foi a mais prevalente. Conclusões: A ressecção por via posterior mostrou ser uma opção segura e eficaz no tratamento da cifose por tuberculose vertebral. Nível de evidência IV; Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN Objetivo: Evaluación de los resultados clínicos y radiológicos de la resección de la columna vertebral por vía posterior (RCVP) en el tratamiento de la cifosis por tuberculosis vertebral. Métodos: Estudio retrospectivo de una serie de 14 casos, 9 del sexo femenino y 5 del sexo masculino, con promedio de edad de 28 años (1 a 64) en el momento de la cirugía, portadores de tuberculosis vertebral con promedio de cifosis de 56,42° (2º a 95°). Resultados: Todos los pacientes fueron sometidos a tratamiento quirúrgico con RCVP, con número promedio de 2,57 (1 a 6) vértebras resecadas y número promedio de vértebras instrumentadas de 6,14 (4 a 8). El promedio de corrección de la cifosis fue de 64%, con hasta un año de seguimiento. Antes de la cirugía, ocho pacientes presentaban señales de sufrimiento medular (puntuación ASIA variando de A a D), y otros seis no presentaban déficit de fuerza o sensibilidad (ASIA E). No hubo empeoramiento neurológico, y todos los que tenían déficit mejoraron al menos un grado en la escala. En el seguimiento postoperatorio, fue evidenciada consolidación ósea en todos los pacientes, excepto en uno. Entre las complicaciones intra y postoperatorias, la pleurotomía fue la más prevalente. Conclusiones: La resección por vía posterior mostró ser una opción segura y eficaz en el tratamiento de la cifosis por tuberculosis vertebral. Nivel de evidencia IV; Estudios terapéuticos: investigación de los resultados del tratamiento.

Increased C-reactive protein in acute ischemic stroke patients is age dependent / El incremento de la proteína C reactiva en pacientes con ictus isquémico agudo varía con la edad

Introduction: Several studies investigating blood biomarkers such as C-reactive protein (CRP) in the prognosis and mortality of stroke have not been conclusive. This may be related to the fact that age has not been taken into account for these analyses. Objective: In the present study, we evaluated the possible relationship of blood markers with the age and clinical characteristics of ischemic stroke patients. Methods: Two groups of acute ischemic stroke patients (≤ 55 years and > 55 years of age) who were paired with a control group were included. CRP, alpha 1 antitrypsin (AAT), complements C3 and C4, microalbuminura, ceruloplasmin, glucose, cholesterol, triglycerides, glutamic-piruvic transaminase (GPT), glutamic-oxalacetic transaminase (GOT), gamma glutamiltranspeptidase (GGT), creatinine, and uric acid were determined. Other clinical information, including NIH stroke scale was collected. Results: AAT, ceruloplasmin, microalbuminuria, GPT, GOT and GGT were significantly increased with respect to control subjects in both age groups. Nevertheless, CRP was increased only in patients older than 55 years. CRP and age were directly correlated in stroke patients, but not in the control group joint analysis of age and NIHSS revealed a tendency towards even higher CRP values in older patients with more severe neurological impairment. Levels of CRP increased significantly with age according to NIH score. Conclusions: Age should be considered when evaluating the usefulness of CRP and other blood biomarkers as clinical tools for predicting long or short-term neurological outcome or stroke recurrence events in ischemic stroke patients(AU)

Introducción: Los estudios sobre marcadores sanguíneos incluido la proteína C reactiva (PCR) en el pronóstico y mortalidad del ictus no han sido concluyentes, quizás porque en sus análisis no se ha tenido en cuenta la edad los pacientes. Objetivo: Evaluar la relación de los marcadores sanguíneos con la edad y características clínicas de pacientes con ictus isquémico. Métodos: Se incluyeron en el estudio 2 grupos de pacientes con ictus isquémico (( y > 55 años) quienes fueron pareados con grupos controles. Fueron determinados: PCR, alfa 1 antitripsina (AAT), complementos C3 y C4, microalbuminuria, ceruloplasmina, glucosa, colesterol, triglicéridos, transaminasa glutámico-pirúvico (TGP), transaminasa glutámico-oxalacético (TGO), gamma glutamiltranspeptidasa (GGT), creatinina, y ácido úrico. También, se recogió información clínica (escala neurológica, etiología y localización del ictus). Resultados: La AAT, ceruloplasmina, microalbuminuria, TGP, TGO y GGT aumentaron significativamente respecto al grupo control de ambos grupos de estudio. Sin embargo, la PCR se incrementó solamente en pacientes mayores de 55 años. La PCR se correlacionó directamente con la edad de los pacientes, pero no en el grupo control. A su vez, se observó una tendencia hacia el aumento de la PCR en pacientes mayores de 55 años con mayor la severidad neurológica. Los valores de PCR se incrementaron estadísticamente con la edad de acuerdo al déficit neurológico. Conclusiones: La edad debiera ser considerada en la evaluación de la utilidad de la PCR y de otros marcadores como herramientas clínicas para predecir un desenlace neurológico fatal o recurrencia de nuevos eventos en pacientes con ictus isquémico(AU)

Acute pancreatitis complicated by encephalopathy

Pancreatic encephalopathy is a frequently under-diagnosed and rare complication of acute pancreatitis. It denotes the occurrence of neuropsychiatric abnormalities in the setting of acute pancreatic inflammation, and presents with neurological symptoms that may persist even after the resolution of all metabolic parameters. Here we present the case of a 42 year old male patient presenting with altered sensorium and focal neurological deficit during the course of acute pancreatitis. The patient was treated conservatively, and later improved with supportive care.

Caracterización de pacientes con accidente cerebrovascular en un servicio de emergencias de Santiago de Cuba / Characterization of patients with stroke in an emergency service from Santiago de Cuba

Introducción: El accidente cerebrovascular es el daño neurológico que ocurre cuando uno de los vasos sanguíneos del cerebro se obstruye por un coágulo (embolia o trombo) o se rompe (hemorragia), lo cual no permite el flujo sanguíneo cerebral. Objetivo: Caracterizar a los pacientes con accidente cerebrovascular atendidos en el Servicio de Emergencias del Hospital Clinicoquirúrgico Docente Dr. Joaquín Castillo Duany de Santiago de Cuba. Métodos: Se realizó un estudio descriptivo y transversal de 122 pacientes con accidente cerebrovascular atendidos en el mencionado Servicio desde octubre de 2016 hasta igual mes de 2017. Se tuvieron en cuenta variables de interés demográficas relacionadas con la enfermedad y se utilizó el porcentaje como medida resumen. Resultados: En la serie predominaron el sexo femenino (58,2 %) y el grupo etario de 61-70 años. Se comprobó que 26,2 % de los afectados permanecieron más de 6 horas en el Servicio de Emergencias y se encontró una asociación de esta enfermedad con la hipertensión arterial, la diabetes mellitus, la cardiopatía isquémica, el hábito de fumar, el alcoholismo y la hiperlipidemia; igualmente, el uso inadecuado del tratamiento farmacológico y de la ventilación mecánica artificial ocasionó una tasa de letalidad elevada. Conclusiones: A pesar de los estudios realizados en esta misma institución, se impone continuar profundizando en el adecuado control y seguimiento de dichos accidentes, así como también desarrollar estrategias que permitan la superación y preparación del personal médico y paramédico de ese centro hospitalario.

Introduction: The stroke is the neurological damage that happens when one of the brain blood vessels is obstructed by a clot (embolism or clot) or it breaks (hemorrhages), which doesn't allow the brain blood flow. Objective: To characterize the patients with stroke assisted in the Emergencies Service of Dr. Joaquín Castillo Duany Teaching Clinical Surgical Hospital in Santiago de Cuba. Methods: A descriptive and cross-sectional study of 122 patients with stroke assisted in the mentioned Service from October, 2016 to the same month in 2017 was carried out. Demographic variables of interest related to the disease were taken into account and the percentage as summary measure was used. Results: The female sex (58.2 %) and 61-70 age group prevailed in the series. It was demonstrated that 26.2 % of those affected stayed more than 6 hours in the Emergencies Service and it was found an association of this disease with hypertension, diabetes mellitus, ischemic heart disease, nicotine addiction, alcoholism and hyperlipemia; equally, the inadequate use of the pharmacological treatment and the mechanic artificial ventilation caused a high lethality rate. Conclusions: In spite of the studies carried out in this same institution, it is important to continue deepening in the appropriate control and follow up of these accidents, as well as to develop strategies that allow training and preparation of the medical and paramedic staff of that hospital.

Osteomielitis cervical asociada a otitis crónica. Presentación de un caso / Cervical osteomyelitis associated with chronic otitis. A case report

Introducción : La osteomielitis es la infección de estructuras óseas ya sea por inoculación directa a través de heridas, por vía hematógena a través de focos distantes o por contigüidad con estructuras vecinas como los oídos. Objetivo: Reportar un caso que demuestra la necesidad de seguimiento de las otitis medias con vistas a evitar recurrencias y complicaciones. Presentación del Caso: Paciente femenina, de 62 años de edad, tez blanca y ama de casa de la localidad de Baracoa, provincia Guantánamo, Cuba. Con antecedentes de otitis de un año de evolución que desarrolló osteomielitis crónica cervical y un cuadro neurológico caracterizado por cuadriparesia y dificultad para la acción asociado a la osteomielitis cervical. Se trató con vancomicina y levofloxacino durante 6 semanas y oxigenación hiperbárica con lo cual egresó totalmente rehabilitada. Conclusiones: El manejo inadecuado de la otitis puede desencadenar complicaciones graves y poco frecuentes como la osteomielitis cervical tal y como se presenta en este caso(AU)

Introduction: Osteomyelitis is the infection of the osseous structures associated with the direct inoculation of microorganisms through wounds, hematogenous route from distant focus of infection or the contiguity with neighboring structures like the ears. Objective: The aim of this paper is to demonstrate the need for medical follow-up of otitis media in order to avoid recurrence and complications of this disease. Case presentation: Sixty-two-year-old white woman, housewife, from Baracoa, Guantanamo Province, Cuba. The patient had antecedents of one-year history of otitis media. She developed cervical chronic osteomyelitis and a neurological picture that was characterized by quadriparesis and difficulty to carry out actions, which was associated with cervical osteomyelitis. She was treated with Vancomycin and Levofloxacin during 6 months and hyperbaric oxygenation that helped her to be totally recovered after discharge from hospital. Conclusions: Inadequate treatment of otitis can cause very serious and less frequent complications such as cervical osteomyelitis, as it is presented in this case(AU)

Analysis of correlation between serum NSE, hs-CRP levels and NIHSS score in patients with cerebral infarction / 中国基层医药

Objective To investigate the correlation between the changes of serum neuron specific enolase(NSE) and hypersensitive C-reactive protein (hs-CRP) levels and the degree of neurological deficit (NIHSS)score in patients with cerebral infarction.Methods From January 2017 to January 2019,63 patients with cerebral infarction admitted to Lishui Central Hospital were selected.According to NIHSS score,they were divided into 13 mild cases,30 moderate cases and 20 severe cases.According to infarction area,they were divided into large area group(16 cases),small area group (27 cases) and lacunar infarction group (20 cases).Another 60 cases underwent health examination in our hospital from January 2017 to January 2019 were selected as the control group.Enzyme-linked immunosorbent assay (ELISA) was used to determine the content of NSE,and immunoturbidimetric assay was used to determine the content of hs-CRP.The changes of serum NSE and hs-CRP levels in the cerebral infarction group and control group,serum NSE,hs-CRP levels and NIHSS scores in different severity and infarction area,and the correlation between serum NSE and hs-CRP changes and NIHSS scores were compared.Results The serum levels of NSE [(21.34 ± 3.27) ng/mL] and hs-CRP [(10.48 ± 2.14) mg/L] in the cerebral infarction group were significantly higher than those in the control group [(6.23 ± 1.08) ng/mL,(2.83 ± 0.46) mg/L] (t =34.061,27.095,all P ＜ 0.05).The serum levels of NSE [(26.98 ± 3.64) ng/mL],hs-CRP [(15.36 ± 2.57) mg/L] and NIHSS score[(38.49 ±3.25) points] in the severe group were higher than those in the moderate group and mild group,which in the moderate group [(20.98 ± 3.21) ng/mL,(10.25 ± 2.09) mg/L and (22.18 ± 3.48) points]were higher than those in the mild group [(12.64 ± 2.78) ng/mL,(5.47 ± 1.40) mg/L and (7.38 ± 2.56)],the differences were statistically significant (F =14.975,9.132,15.873,all P ＜ 0.05).The serum levels of NSE[(25.43 ± 3.35) ng/mL],hs-CRP [(16.54 ± 2.71) mg/L] and NIHSS score [(37.34 ± 3.75) points] in the large area group were higher than those in the small area group and lacunar infarction group,which in the small area group [(21.67 ± 3.12) ng/mL,(10.86 ± 2.21) mg/L and (21.25 ± 3.26) points] were higher than those in the lacunar infarction group [(13.45 ± 2.97) ng/mL,(4.79 ± 1.35) mg/L and (8.49 ± 2.15) points],the differences were statistically significant (F =13.241,9.893,17.482,all P ＜ 0.05).The serum levels of NSE and hs-CRP were positively correlated with NIHSS score (r =0.829,0.713,all P ＜ 0.05).Conclusion The levels of serum NSE and hs-CRP in patients with cerebral infarction increase with the progression of the disease,and there is a linear positive correlation between NSE and hs-CRP and NIHSS score.It is considered that NSE and hs-CRP are of great value in evaluating the degree of neurological impairment,the severity of the disease and the size of the infarct.

Analysis of serum S-100 beta protein,NSE and neurological deficits in patients with cerebral infarction and reperfusion treated with butylphthalide / 中国基层医药

Objective To investigate the effects of butylphthalide on serum S-100 beta protein,NSE and neurological deficits in patients with cerebral infarction and reperfusion.Methods From January 2016 to January 2018,104 patients with early cerebral infarction admitted to the People's Hospital of Feicheng were divided into two groups according to different treatment methods.The control group (n =52) was given routine treatment,while the observation group (n =52) was given butylphthalide treatment on the basis of the control group.The degree of neurological deficit,serum NSE and S-100 beta protein levels were compared between the two groups before and after thrombolysis.Results The NIHSS scores of the two groups before thrombolysis were (10.27 ± 1.32) points and(10.28 ± 1.30) points,respectively,the difference between the two groups was no statistically significant(t =0.038,P ＞ 0.05).The NIHSS scores of the two groups were decreased at 24h and 7d after thrombolysis,which of the observation group at 24h and 7d after thrombolysis were (8.32 ± 1.37)points and (4.25 ± 1.54)points,respectively,which were significantly lower than those of the control group [(9.24 ± 1.40) points and (9.50 ± 1.24) points],the differences were statistically significant (t =3.396,19.147,all P ＜ 0.05).The serum NSE levels of the two groups before thrombolysis were (22.56 ± 5.78) U/mL and (22.58 ± 5.77) U/mL,respectively,the difference between the two groups was no statistically significant (t =0.017,P ＞ 0.05).At 24h and 7d after thrombolysis,the serum NSE levels of the two groups were decreased.The serum NSE levels of the observation group at 24h and 7d after thrombolysis were (15.08 ± 9.35) U/mL and (13.25 ± 6.47) U/mL,respectively,which were significantly lower than those in the control group [(18.96 ± 10.14)U/mL and (16.98 ± 7.11) U/mL],the differences were statistically significant(t =2.028,2.79,all P ＜ 0.05).The serum S-100β protein levels in the two groups before thrombolysis were(1.26 ± 0.71)μg/L and (1.27 ± 0.70)μg/L,respectively,and the difference was not significant (t =0.0723,P ＞0.05).At 24h and 7d after thrombolysis,the serum S-100β protein levels were decreased in both two groups,which in the observation group were (1.13 ± 0.62) μg/L and (0.53 ± 0.48) μg/L,respectively,which were significantly lower than those in the control group [(1.40 ± 0.64) μg/L,(0.87 ± 0.32) μg/L],the differences were statistically significant (t =2.185,4.25,all P ＜ 0.05).Conclusion Butylphthalide injection for patients with cerebral infarction and reperfusion can effectively promote the recovery of neurological function,improve the levels of serum NSE and S-100 beta protein,and help patients recover as soon as possible.

Delayed Post-operative Spinal Epidural Haematoma after Posterior Spinal Surgery: Report of Two Cases

@#Delayed post-operative spinal epidural haematoma (DPSEH) is diagnosed when the onset of symptoms is more than three days from the index surgery. DPSEH is a rare but serious complication of spinal surgery. Missed diagnosis will result in irreversible neurological deficit which may lead to permanent disabilities. We report two cases of DPSEH who presented with worsening neurological deficit four days after the index surgery. Magnetic resonance imaging (MRI) showed the presence of an epidural haematoma compressing the spinal cord. Surgical evacuation of haematoma were performed for both patients. Both patients experienced neurological improvement. Surgeons should have high index of suspicion to identify delayed onset of spinal epidural haematoma (SEH) and timely intervention should be taken to avoid irreversible neurological damage.

Study on Improvement Effects of Z-guggulsterone Combined with Acetyl- 11-keto-β-boswellic Acid on Cerebral Ischemia- reperfusion Injury Model Rats / 中国药房

OBJECTIVE： To study the improvement effects of Z-guggulsterone （Z-GL） combined with acetyl-11-keto-β- boswellic acid （AKBA） on cerebral ischemia-reperfusion injury model rats. METHODS： Male SD rats were randomly divided into sham operation group， model group， Z-GL+AKBA low-dose and high-dose groups （25， 50 mg/kg）， with 10 rats in each group. Except for sham operation group， middle cerebral artery occlusion/reperfusion injury model was induced by suture method in other groups. Administration groups were given relevant medicine intragastrically after reperfusion； sham operation group and model groups were given constant volume of DMSO intragastrically， every 12 h， for consecutive 7 d. The neurological deficits were evaluated with modified Longa score； HE staining was performed to observe the pathological changes of cerebral tissue in rats； the area of cerebral infarction was measured by TTC， and the percentage of cerebral infarction area； TUNEL staining was performed to detect apoptotic neurons. The expression of CD34， VEGF and DLL4 were detected by immunofluoresence and immunoblotting assay， respectively. RESULTS： Compared with sham operation group， the number of cortical cells in the model group decreased and arranged irregularly， with obvious infarct area and obvious decrease of neovascularization； the neurological deficit score， the percentage of cerebral infarction area and TUNEL positive cells increased significantly， while the expression of CD34， VEGF and DLL4 decreased significantly （P＜0.05 or P＜0.01）. Compared with model group， the above symptoms of the rats in each administration group were significantly improved， the neurological deficit score， the percentage of cerebral infarction area and the number of TUNEL positive cells were significantly reduced； the expression levels of CD34， VEGF and DLL4 were significantly increased； the neurological deficit score， the percentage of cerebral infarction area and the number of TUNEL positive cells in Z-GL+AKBA high-dose group were significantly lower or less than low dose group； the expression of CD34 and DLL4 in high-dose group was significantly higher than low-dose group （P＜0.05 or P＜0.01）. CONCLUSIONS： Z-GL combined with AKBA can relieve neurological deficit and cerebral injury of cerebral ischemia-reperfusion injury model rats， which may be related to promoting angiogenesis and up-regulating the expression of VEGF and DLL4 protein， with a certain dose-dependent effect.

Study on Improvement Effects of Fingolimod on MCAO/R Injury Model Rats / 中国药房

OBJECTIVE： To observe improvement effects of fingolimod on middle cerebral artery occlusion/reperfusion （MCAO/R） injury model rats. METHODS： Male SD rats were randomly divided into sham operation group， model group and fingolimod low-dose， medium-dose and high-dose groups （0.5， 1， 2 mg/kg）， with 8 rats in each group. Except for sham operation group， MCAO/R injury model was induced by suture-occluded method in other groups. Administration groups were given relevant medicine intragastrically after reperfusion [1 h after reperfusion （1st day）， 22.5 h after reperfusion （2nd day）， and then every 24 h until 142.5 h of reperfusion （7th day）]. Sham operation group and model group were given constant volume of normal saline intragastrically， once a day， for consecutive 7 d. The scores of neurological deficit and balance beam test， the times of memory error [work memory error （WME）， reference memory error （RME） and total error] were recorded in each group. The contents of serum inflammatory cytokines （IL-6， IL-8， IL-10， TNF-α） were determined by ELISA， and triphenyl tetrazolium chloride staining method was used to detect the rate of cerebral infarction. RESULTS： Compared with sham operation group， neurological deficit scores （at different time points of 1st-7th day after administration）， balance beam test scores （2nd， 4th， 7th day after administration）， times of memory error （2nd， 4th， 7th day after administration）， the contents of serum inflammatory cytokines and the rate of cerebral infarction were increased significantly in model group （P＜0.05 or P＜0.01）. Compared with model group， neurological deficit scores （low-dose group at different time points of 3rd-7th day， medium-dose and high-dose groups at different time points of 2nd-7th day after administration）， balance beam test scores （low-dose group at 7th day， medium-dose group at 4th and 7th day， high-dose group at 2nd， 4th， 7th day）， RME times and total error times （low-dose group at 4th and 7th day， medium-dose group and high-dose group at 2nd， 4th， 7th day after administration）， WME times （administrations groups at 7th day after administration）， serum contents of IL-6， IL-8 and IL-10 （administrations groups）， serum contents of TNF-α （medium-dose and high-does groups） and cerebral infarction rate （medium-dose and high-dose groups） were all decreased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS： Intragastric administration of fingolimod can significantly reduce neurological deficit score， balance beam test score and the times of memory error in MCAO/R injury model rats， and has a protective effect on cerebral tissue and memory function. These effects may be related to the down-regulation of inflammatory cytokines such as IL-6 and TNF-α by fingolimod.

Comparison between two rat models of cardiac arrest: asphyxiation and ventricular fibrillation / 上海交通大学学报（医学版）

Objective: To compare the differences in cardiac function and neurological function between asphyxia and ventricular fibrillation (VF) induced cardiac arrest rat model. Methods: Twenty healthy adult male SD rats were randomly divided into VF group (n=8), asphyxial group (n=8) and sham group (n=4). Cardiac arrest models were established in VF group and asphyxial group by VF and asphyxia respectively. All animals were observed for 24 h and advanced life support was offered for the first 1 h after resuscitation. During the 24 h, ejection fraction (EF) and cardiac output (CO) were measured with the help of cardiac ultrasonography at 1, 3, 5 and 6 h post resuscitation. Electrocardiographic changes, 24 h survival analysis and neurological deficit score (NDS) were also recorded and analyzed at 6, 12, 18 and 24 h post resuscitation. Results: Both EF and CO decreased dramatically after resuscitation compared with sham group at the same time point (P=0.000). At 1 h post resuscitation, the CO decreased from (98.84±4.86) mL/min to (59.17±22.99) mL/min in VF group and from (99.86±10.34) mL/min to (46.02±22.32) mL/min in asphyxial group, but there was no difference between the two groups (P=0.792). At 3, 5 and 6 h post resuscitation, the CO in VF group was higher than that in asphyxial group (P=0.041, P=0.007, P=0.020). At 1 h post resuscitation, the EF decreased from (82.67±6.21)% to (70.23±13.24)% in VF group and from (83.24±3.01)% to (65.46±13.11)% in asphyxial group, but no difference was observed between the two groups (P=0.877). Then a recovery tendency was observed in both groups, but more obvious in VF group at 3 and 5 h post resuscitation (P=0.031, P=0.024). No difference was found between the two groups in survival rate during 24 h and the NDS after resuscitation, although the neurological function was greatly impaired. Conclusion: VF and asphyxia are most commonly used methods to induce cardiac arrest, but these models may differ in cardiac function post resuscitation. Researchers need to choose appropriate models according to their study objectives.

Comparison between two rat models of cardiac arrest: asphyxiation and ventricular fibrillation / 上海交通大学学报（医学版）

Objective·To compare the differences in cardiac function and neurological function between asphyxia and ventricular fibrillation (VF)induced cardiac arrest rat model.Methods·Twenty healthy adult male SD rats were randomly divided into VF group (n=8),asphyxial group (n=8)and sham group (n=4).Cardiac arrest models were established in VF group and asphyxial group by VF and asphyxia respectively.All animals were observed for 24 h and advanced life support was offered for the first 1 h after resuscitation.During the 24 h,ejection fraction (EF) and cardiac output (CO) were measured with the help of cardiac ultrasonography at 1,3,5 and 6 h post resuscitation.Electrocardiographic changes,24 h survival analysis and neurological deficit score (NDS) were also recorded and analyzed at 6,12,18 and 24 h post resuscitation.Results·Both EF and CO decreased dramatically after resuscitation compared with sham group at the same time point (P=0.000).At 1 h post resuscitation,the CO decreased from (98.84±4.86)mL/min to (59.17±22.99) mL/min in VF group and from (99.86±10.34) mL/min to (46,02±22.32) mL/min in asphyxial group,but there was no difference between the two groups (P=0.792).At 3,5 and 6 h post resuscitation,the CO in VF group was higher than that in asphyxial group (P=0.041,P=0.007,P=0.020).At 1 h post resuscitation,the EF decreased from (82.67±6.21)％ to (70.23±13.24)％ in VF group and from (83.24±3.01)％ to (65.46±13.11)％in asphyxial group,but no difference was observed between the two groups (P=0.877).Then a recovery tendency was observed in both groups,but more obvious in VF group at 3 and 5 h post resuscitation (P=0.031,P=0.024).No difference was found between the two groups in survival rate during 24 h and the NDS after resuscitation,although the neurological function was greatly impaired.Conclusion·VF and asphyxia are most commonly used methods to induce cardiac arrest,but these models may differ in cardiac function post resuscitation.Researchers need to choose appropriate models according to their study objectives.

Mesenchymal stem cells transplantation improves functional recovery after cardiac arrest: contribution of necroptosis / 中华急诊医学杂志

Objective To explore the effects of bone marrow mesenchymal stem cells (MSCs) transplantation on receptor-interacting protein kinase 1 (RIP1) and RIP3 in rat brain after cardiac arrest (CA).Methods Sprague Dawley (SD) rats were randomly (random number) divided into sham group (n=8),CA group (n=8) and MSCs group (n=8).Animals were subjected to asphyxial cardiac arrest and followed by cardiopulmonary resuscitation (CPR).In MSCs group or CA group,animals received intravenous injection of 1 × 106 MSCs in 0.5 mL phosphate buffer solution (PBS) or 0.5 mL PBS alone at 1 h after successful resuscitation.Neurological deficit scores (NDS) were assessed at 3 d after CPR.Donor MSCs in brain were detected under a fluorescent microscope.HE staining of brain tissue was performed to observe necrotic neurons.Western blot analysis was performed to measure the levels of RIP1 and RIP3 in brain.Multiple comparisons were made by analysis of variance or Kruskal-Wallis H test.Results At 3 d after CPR,MSCs group demonstrated higher NDS than CA group [72.5(71.5,73.2) vs.63.0(62.5,64.1),Z=3.376,P=0.001].DAPI-labeled MSCs were primarily observed in the cerebral cortex.The percentage of necrotic neurons in MSCs group was significantly lower than that in CA group [(29.6±5.9)％ vs.(57.2±6.4)％,t=8.922,P＜0.01].The levels of RIP1 and RIP3 expression in brain in MSCs group were significantly lower than those in CA group [RIP1:0.227(0.193,0.243) vs.0.599(0.535,0.629),Z=3.151,P=0.001;RIP3:0.217(0.203,0.274) vs.0.543(0.533,0.555),Z=3.361,P=0.001].Conclusion MSCs transplantation improves neurological function after CPR from CA in rats likely associated with inhibiting necroptosis.

Lumbopelvic Fixation and Sacral Decompression for U-shaped Sacral Fractures: Surgical Management and Early Outcome / 华中科技大学学报（医学）（英德文版）

U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries.These fractures are highly unstable and frequently cause neurological deficits.The majority of surgeons have limited experience in management of U-shaped sacral fractures.No standard treatment protocol for U-shaped sacral fractures has been available till now.This study aimed to examine the management of U-shaped sacral fractures and the early outcomes.Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed.Demographics,fracture classification,mechanism of injury and operative treatment and deformity angle were assessed.All the patients were treated with lumbopelvic fixation or (and) sacral decompression.EQ-5d score was applied to evaluate the patients' quality of life.Of the 15 consecutive patients with U-shaped sacral fracture,the mean age was 28.8 years (range:15-55 years) at the time of injury.There were 6 females and 9 males.The mean followup time was 22.7 months (range:9-47 months) and mean full weight-bearing time was 9.9 weeks (range:8-14 weeks).Ten patients received lumbopelvic fixation and sacral decompression,one lombosacral fixation,and 4 merely sacral decompression due to delayed diagnosis or surgery.The post-operation deformity angle (mean 27.87°,and range:8°-90°) of the sacrum was smaller than that pre-operation (mean 35.67;range:15-90) with no significance difference noted.At the latest follow-up,all patients obtained neurological recovery with different extents.Visual analogue score (VAS) was reduced from preoperative 7.07 (range:5-9) to postoperetive 1.93 (range:1-3).All patients could walk without any aid after treatment.Eight patients were able to care for themselves and undertook some daily activities.Five patients had returned to work full time.In conclusion,lumbopelvic fixation is an effective method for stabilization of U-shaped sacral fractures with fewer complications developed.Effective reduction and firm fixation are the prerequisite of early mobilization and neurological recovery.Sacral decompression effectively promotes neurological recovery even in patients with old U-shaped sacral fractures.

Lumbopelvic Fixation and Sacral Decompression for U-shaped Sacral Fractures: Surgical Management and Early Outcome / 华中科技大学学报（医学）（英德文版）

U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries.These fractures are highly unstable and frequently cause neurological deficits.The majority of surgeons have limited experience in management of U-shaped sacral fractures.No standard treatment protocol for U-shaped sacral fractures has been available till now.This study aimed to examine the management of U-shaped sacral fractures and the early outcomes.Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed.Demographics,fracture classification,mechanism of injury and operative treatment and deformity angle were assessed.All the patients were treated with lumbopelvic fixation or (and) sacral decompression.EQ-5d score was applied to evaluate the patients' quality of life.Of the 15 consecutive patients with U-shaped sacral fracture,the mean age was 28.8 years (range:15-55 years) at the time of injury.There were 6 females and 9 males.The mean followup time was 22.7 months (range:9-47 months) and mean full weight-bearing time was 9.9 weeks (range:8-14 weeks).Ten patients received lumbopelvic fixation and sacral decompression,one lombosacral fixation,and 4 merely sacral decompression due to delayed diagnosis or surgery.The post-operation deformity angle (mean 27.87°,and range:8°-90°) of the sacrum was smaller than that pre-operation (mean 35.67;range:15-90) with no significance difference noted.At the latest follow-up,all patients obtained neurological recovery with different extents.Visual analogue score (VAS) was reduced from preoperative 7.07 (range:5-9) to postoperetive 1.93 (range:1-3).All patients could walk without any aid after treatment.Eight patients were able to care for themselves and undertook some daily activities.Five patients had returned to work full time.In conclusion,lumbopelvic fixation is an effective method for stabilization of U-shaped sacral fractures with fewer complications developed.Effective reduction and firm fixation are the prerequisite of early mobilization and neurological recovery.Sacral decompression effectively promotes neurological recovery even in patients with old U-shaped sacral fractures.

Study on the relationship between the level of serum albumin (ALB) and fibrinogen (FIB) in patients with cerebral infarction / 中国基层医药

Objective To study and explore the relationship between neural function defect and plasma albumin (ALB) and fibrinogen (FIB) level in young patients with cerebral infarction .Methods 83 young patients with cere-bral infarction were selected as the observation group ,62 healthy people were randomly selected as the control group . The serum albumin,fibrinogen and neurological deficit scores were compared between the two groups .According to the degree of nervous function defect ,the patients of the observation group were divided into mild group ,moderate group and severe group,the plasma albumin in patients with different neurologic impairment and the level of fibrinogen were compared.Results Compared to the control group, the plasma albumin [(51.64 ±13.91 ) g/L], fibrinogen [(6.59 ±2.93)g/L] and neurological deficit scores [(22.95 ±14.32)points] in the observation group were signifi-cantly higher (t =8.132,10.764,10.888,all P <0.05).In the observation group,the plasma albumin and fibrinogen levels had statistically significant differences in patients with different degree of neural function defect (F =9.959, 7.192,all P <0.05),and plasma albumin,fibrinogen were positively correlated with neurological deficits (r =0.635, 0.726,all P <0.05).Conclusion The serum albumin and fibrinogen levels in young patients with cerebral infarc-tion are abnormally increased,their expression levels are closely related with neural function defect degree ,and can be used as important indicators of disease monitoring ,assessment of prognosis.