Military Brain Science - How to influence future wars / 中华创伤杂志(英文版)

Military Brain Science is a cutting-edge innovative science that uses potential military application as the guidance. It was preliminarily divided into 9 aspects by authors: understanding the brain, protecting the brain, monitoring the brain, injuring the brain, interfering with the brain, repairing the brain, enhancing the brain, simulating the brain and arming the brain. In this review, we attempt to propose the concept, content and meaning of the Military Brain Science, with the hope to provide some enlightenment and understanding of the research area.

Definition and application of precision medicine / 中华创伤杂志(英文版)

"No abstract".

Blast-induced traumatic brain injury: a new trend of blast injury research / 中华创伤杂志(英文版)

Blast injury has become the major life- and function-threatening injuries in recent warfares. There is increased research interest in the mental disorders caused by blast-induced traumatic brain injury (bTBI), which has been proved as one of the "signature wounds" in modern battlefield. We reviewed the recent progresses in bTBI-related researches and concluded that the new era of blast injury research has shifted from the traditional physical impairments to cognitive dysfunctional/mental disorders that are proved to be more related to the outcome of combat casualty care.

Enhance the establishment of wound healing centers and promote the specialized treatment of chronic skin wounds / 中华烧伤杂志

It is important to establish some comprehensive wound healing centers in order to treat those complicated chronic skin wounds. In this paper, I would like to summarize our practices in some hospitals dealing with the construction of wound healing centers and give my suggestions for their future development.

Viewpoint on the current status of researches on sepsis / 解放军医学杂志

Sepsis is a common complication after severe trauma and burn, and also one of the main causes of death. Recently, although some new progresses were seen in antibiotic therapy, the mortality of sepsis is still on the rise, and the death rate as a result of sepsis is higher than a total of that of prostate cancer, breast cancer and AIDS. Therefore, sepsis has obviously become one of the serious ailments threatening human health. The present paper introduced the international definition of sepsis, severe sepsis and septic shock, the current researches on diagnosis and therapy, and proposed that we should not only pay attention to pathogenesis and treatment, but also to sepsis prevention in sepsis researches, and we should try to find out the breakthrough in the interaction and dynamic balance between human being and pathogenic factors. Researches on the strategies to revert strong toxicity of infectious agents to non-toxic or weak pathogenic factors, and to conduct further research concerning biological characteristics of microorganisms and mechanism of drug resistance in order to render them to lose the drug resistance ability, or to increase its sensitivity to the drugs. The above suggested approaches might form the future strategies for preventing and controlling sepsis.

Researches on regenerative medicine-current state and prospect / 中华创伤杂志(英文版)

Since 1980s, the rapid development of tissue engineering and stem cell research has pushed regenerative medicine to a new fastigium, and regenerative medicine has become a noticeable research field in the international biology and medicine. In China, about 100 million patients need repair and regeneration treatment every year, while the number is much larger in the world. Regenerative medicine could provide effective salvation for these patients. Both Chinese Academy of Sciences and Chinese Academy of Engineering have made roadmaps of 2010-2050 and 2011-2030 for regenerative medicine. The final goal of the two roadmaps is to make China go up to leading position in most research aspects of regenerative medicine. In accord with this strategy, the government and some enterprises have invested 3-5 billion RMB (0.5-0.8 billion USD) for the research on regenerative medicine. In order to push the translation of regenerative medicine forward-from bench to bedside, a strategic alliance has been established, and it includes 27 top-level research institutes, medical institutes, colleges, universities and enterprises in the field of stem cell and regeneration medicine. Recently the journal, Science, has published a special issue-Regenerative Medicine in China, consisting of 35 papers dealing with stem cell and regeneration, tissue engineering and regeneration, trauma and regeneration and bases for tissue repair and regenerative medicine. It is predicated that a greater breakthrough in theory and practice of regenerative medicine will be achieved in the near future (20 to 30 years).

Cervical spinal canal narrowing and cervical neurological injuries / 中华创伤杂志(英文版)

Cervical spinal canal narrowing can lead to injury of the spinal cord and neurological symptoms including neck pain, headache, weakness and parasthesisas. According to previous and recent clinical researches, we investigated the geometric parameters of normal cervical spinal canal including the sagittal and transverse diameters as well as Torg ratio. The mean sagittal diameter of cervical spinal canal at C(1) to C(7) ranges from 15.33 mm to 20.46 mm, the mean transverse diameter at the same levels ranges from 24.45 mm to 27.00 mm and the mean value of Torg ratio is 0.96. With respect to narrow cervical spinal canal, the following charaterstics are found: firstly, extension of the cervical spine results in statistically significant stenosis as compared with the flexed or neutral positions; secondly, females sustain cervical spinal canal narrowing more easily than males; finally, the consistent narrowest cervical canal level is at C(4) for all ethnicity, but there is a slight variation in the sagittal diameter of cervical spinal stenosis (less than or equal to 14 mm in Whites, less than or equal to 12 mm in Japanese, less than or equal to 13.7 mm in Chinese). Narrow sagittal cervical canal diameter brings about an increased risk of neurological injuries in traumatic, degenerative and inflammatory conditions and is related with extension of cervical spine, gender, as well as ethnicity. It is hoped that this review will be helpful in diagnosing spinal cord and neurological injuries with the geometric parameters of cervical spine in the future.

Influence of degenerative changes of intervertebral disc on its material properties and pathology / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the material properties of normal and degenerated intervertebral discs (IVDs) and examine the effect of degenerative changes on IVD pathology.</p><p><b>METHODS</b>A computer-based online search was undertaken to identify English articles about material properties of IVDs published from January 1950 to 2011 in PubMed database. The retrieved keywords included material properties, intervertebral disc and degeneration. Based on the principles of reliability, advancement and efficiency, the obtained data were primarily examined, and the original source was retrieved to read the full-text. Repetitive articles were excluded. The data of material properties of normal and degenerated IVDs were summarized and analyzed by meta-analysis.</p><p><b>RESULTS</b>The data of Young's modulus, Poisson's ratio, shear modulus, hydraulic permeability and intradiscal pressure of normal and degenerated IVDs were obtained. Compared with normal IVDs, the Young's modulus and shear modulus of annulus fibrosus and nucleus pulposus were higher in degenerated IVDs, the Poisson's ratio was lower while the hydraulic permeability and intradiscal pressure were higher. Besides, the degeneration-related alterations in IVDs had an influence both on itself and other spinal structures, leading to diseases such as bulging disc, discogenic pain and spinal stenosis. Meanwhile, the heavy mechanical loading and injury indicated important pathways to IVD degeneration.</p><p><b>CONCLUSIONS</b>To a certain extent, the degenerative changes of IVD influence its material properties. And the degeneration-related alterations of composition can cause structural failure of IVDs, leading to injuries and diseases.</p>

Analysis of 86 fatal motorcycle frontal crashes in Chongqing, China / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To analyze the injuries of motorcyclists involved in fatal motorcycle frontal crashes.</p><p><b>METHODS</b>A survey group involving multi-discipline experts was built to randomly collect data on fatal motorcycle frontal collision accidents that occurred in Chongqing during 2006-2010. The sampled information included medical or autopsy reports, blood alcohol concentration (BAC) level, helmet use, accident witness, field sketch as well as field photos. The motorcyclist injuries were scored according to the Abbreviated Injury Scale (AIS) 2005. The involved riders with a BAC level larger than or equal to 20 mg/ml were attributed to alcohol use. Data were processed statistically with nonparametric test via software SPSS 11.0.</p><p><b>RESULTS</b>A total of 86 fatal motorcycle frontal crashes were sampled and further analyzed. The age of motorcyclists enrolled in this investigation showed nominal distribution and the middle-aged (30-39 years) occupied the highest percentage of fatalities. There were only 14 motorcyclists (16.3%) wearing helmets at the moment of collision. And 12.8% of these motorcyclist crashes were attributable to alcohol use. Impact injury was the main fatal cause, accounting for 72% of motorcyclist deaths, followed by tumbling injury (26%) and run-over (2%). Respectively 84%, 22% and 19% of motorcyclists who sustained head, chest and abdominal trauma died. Extremity injury was the most frequently observed injury type.</p><p><b>CONCLUSIONS</b>This investigation is helpful to build accident prevention programs and develop protection devices which may effectively mitigate injuries and prevent deaths following motorcycle frontal collision accidents. Further investigations on motorcycle collision accidents are still needed.</p>

Experimental study on calibration system of side-impact dummy neck / 医用生物力学

Objective To investigate the design approaches and manufacturing techniques for the calibration system of side impact dummy neck. Method The ES-2 side impact dummy neck was selected as the research subject and a set of calibration system of ES 2 side impact dummy neck was developed in this experiment according to the pendulum impact theory, and the new design approaches and new manufacturing techniques suitable for the present industrial conditions in China were created to establish its two key components: the pendulum device and the head-neck flexion angle measurement device. The optimal designs for the quality distribution and inertia moment distribution of the whole pendulum were also carried out to assure the pendulum initial velocity and the pendulum impact velocity time curve during the pendulum absorber impact, while optimal designs for three angle sensors and the complex stereoscopically dependent relationship among those three sensors were carried out to assure the reliability of the head neck flexion angle measurement device. Correspondingly, a total of six calibration tests were carried out to validate this calibration system in terms of the technical requirements of ECE R95. Results The pendulum initial velocity of 3.36～3.48 m/s and the pendulum impact velocity time curve during the pendulum absorber impact, which were generated by the pendulum device in this calibration system of ES 2 side impact dummy neck, were in accordance with the ECE R95. Meanwhile, the head neck flexion angle measurement device of this calibration system was sufficient to detect the following three target angle values more accurately: the maximum values of fore pendulum base angles, the maximum values of aft pendulum base angles, and the maximum values of head neck complex flexion angles. Conclusions The calibration system of ES-2 side impact dummy neck is basically capable of meeting the demands of the existing international rule, the ECE R95. Besides, this neck calibration system is convenient and practical, and its design approaches and manufacturing techniques are likely to find the wider application in the impact biomechanics field.

Vibration test for evaluating the spinal stability following fixation of thoracolumbar burst fracture in pigs / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the feasibility of vibration test in evaluation of spinal stability after instrument fixation of thoracolumbar burst fracture in pigs.</p><p><b>METHODS</b>Twenty-one porcine spines (T11 to L5) were impacted longitudinally with different energy levels to simulate thoracolumbar burst fracture. The fractures were fixed by Luque, Harrington, Steffee and Kaneda techniques, and the anterior-posterior, lateral and vertical spinal stability was analyzed using vibration test.</p><p><b>RESULTS</b>In the mild injury group, vibration test showed that only the first order frequency showed marked anterior shift in the vertical direction (P<0.05) but the main frequency did not, suggesting loosening between the vertebrae. In moderate- or high-energy impact groups, the main frequency markedly shifted forward in the vertical and anterior-posterior directions (P<0.05 or P<0.01), and obvious lateral shift was observed only in high-energy impact group.</p><p><b>CONCLUSION</b>The dynamical characteristics of the spine indicate that the main frequency markedly shift after instrument fixation (except for Luque) of thoracolumbar burst fracture, suggesting the feasibility of vibration test for evaluating spinal injury severity and instrument fixation.</p>

Establishment of the model of motorcyclist ejection injury / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To establish the device and model of motorcyclist ejection injury.</p><p><b>METHODS</b>Based on our laboratory devices, a motorcyclist ejection injury simulation system was developed. A total of 18 pigs were approved by the local animal experimentation and ethics committee to serve as the motorcyclist substitutes. In this ejection motion, the animal rode freely at the motor driver seat and was straightly accelerated by means of our custom motorcyclist ejection injury simulation system. When it was speeded up to the preset velocity (v equal to 30, 40 or 50 km/h) at the preset position, the animal was ejected forward. Pathological and dynamic analyses were conducted, accompanied with the high-speed photograph, acceleration/velocity signal test, gross observation and light microscope examination as well as the abbreviated injury score-injury severity score (AIS-ISS) scale.</p><p><b>RESULTS</b>The high-speed photograph indicated that during the ejection procedure the motorcycle was first arrested and decelerated suddenly, and then the motorcycle driver was ejected forward, accompanied with the rotation motion in the air. Finally, the head, shoulder and thorax of the ejected animal impacted directly on the hard ground. Varying degrees of injury focusing on the liver, heart, lung and spleen were found. There existed a significant positive correlation between ISS and the ejection velocity of the motorcycle drivers (ISS equal to 16.7+/-2.9 for 30 km/h, 25.0+/-0.0 for 40 km/h and 37.3+/-1.0 for 50 km/h). The detailed injury characteristics were as follows: for the mildly injured animals, there were interlobar gaps or leaf gaps and lobar surface blood coagulation blocks in the liver, and mild lung hemorrhage; for the severely injured animals, there were liver comminuted laceration, moderate lung hemorrhage and heart injury. Animals suffering from the most severe injuries died half an hour later.</p><p><b>CONCLUSION</b>The new injury model stated in this paper has a high stability and good repeatability, and is likely to be helpful to deeply investigate the injury mechanisms and protection countermeasures of motorcyclist ejection injury.</p>

X-ray observation on how axial compression stimulates tibial fracture healing / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To validate the hypothesis that there exists an optimal axial compression stress range to enhance tibial fracture healing.</p><p><b>METHODS</b>Rabbits with a surgically induced V-shaped tibial fracture were separated into 2 main groups: the control group (C Group, n equal to 6) without application of any axial compression stress stimulation postoperatively and the stimulation group (S Group, n equal to 90). The S Group was further divided into 20 subgroups (S11 to S54) in terms of 5 axial compression stress stimulation levels (112.8 kPa, 289.8 kPa, 396.5 kPa, 472.7 kPa, and 602.3 kPa) and 4 experimental endpoints (1, 3, 5 and 8 weeks after operation). A custom made circular external fixator was used to provide the axial compression stress of the fracture sites. Based on X-ray observation, a fracture healing scoring system was created to evaluate the fracture healing process.</p><p><b>RESULTS</b>At 8 weeks after operation, there existed a "arch shape" relationship between healing score and axial compression stress stimulation level of fracture site. The optimal axial compression stress stimulation ranged from 289.8 kPa to 472.7 kPa, accompanying the best fracture healing, i.e. the fracture line became indistinct or almost disappeared, and a lot of callus jointed the two fracture ends. Meanwhile, at 5 weeks after operation, corresponding to the relatively low healing scores, there was a fracture healing performance similar to that at 8 weeks. Besides, at 1 or 3 weeks after operation, for all the axial compression stress levels (0-602.3 kPa), no obvious healing effect was found.</p><p><b>CONCLUSIONS</b>It is implied from the stated X-ray observation results in this study that the potential optimal axial compression stress stimulation and optimal fracture healing time are available. The axial compression stress level of 289.8-472.7 kPa and fracture healing time of more than 8 weeks jointly comprise the optimal axial compression stress stimulation conditions to enhance tibial fracture healing.</p>

Stimulating effect of sera from severe trauma patients on NF-kappaB activity in macrophage and its relationship with patients prognosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the stimulating effect of sera from severe multiple trauma patients within 24 h post trauma on nuclear factor-kappaB (NF-kappaB) activity in macrophage and their relationship with patients prognosis.</p><p><b>METHODS</b>Peripheral blood of 47 patients with multiple traumas with injury severity score (ISS) > or = 16 and 24 healthy volunteers were obtained, and sera samples were isolated. And 24 h after transfection of the recombinant NF-kappaB plasmid containing luciferase reporter gene into the mouse macrophage line (RAW 264.7), the cells were stimulated by sera from different patients for 6 h, then stimulating effect of sera on NF-kappaB was assessed by luciferase activity. The concentrations of interleukin-1 beta, tumor necrosis factor alpha, interleukin-10, interleukin-1 receptor antagonist, and soluble tumor necrosis factor receptor I were detected with ELISA kits.</p><p><b>RESULTS</b>The stimulating activity of sera from trauma patients on NF-kappaB was increased significantly, and it was higher in MODS group, non-survivor group than that in non-MODS, survivor group respectively. The level of activity was correlated positively with APACHE II score, while it did not have relationship to the cytokine or endogenous antagonist levels. The area under the receiver operating characteristic curve (ROC) of NF-kappaB activity for predicting MODS and mortality was significantly higher than that of APACHE II score.</p><p><b>CONCLUSION</b>Early measurement of NF-kappaB stimulating activity of sera from severe multiple trauma patients may have the value to predict occurrence of MODS and mortality.</p>

Biomechanics of whiplash injury / 中华创伤杂志(英文版)

Despite a large number of rear-end collisions on the road and a high frequency of whiplash injuries reported, the mechanism of whiplash injuries is not completely understood. One of the reasons is that the injury is not necessarily accompanied by obvious tissue damage detectable by X-ray or MRI. An extensive series of biomechanics studies, including injury epidemiology, neck kinematics, facet capsule ligament mechanics, injury mechanisms and injury criteria, were undertaken to help elucidate these whiplash injury mechanisms and gain a better understanding of cervical facet pain. These studies provide the following evidences to help explain the mechanisms of the whiplash injury: (1) Whiplash injuries are generally considered to be a soft tissue injury of the neck with symptoms such as neck pain and stiffness, shoulder weakness, dizziness, headache and memory loss, etc. (2) Based on kinematical studies on the cadaver and volunteers, there are three distinct periods that have the potential to cause injury to the neck. In the first stage, flexural deformation of the neck is observed along with a loss of cervical lordosis; in the second stage, the cervical spine assumes an S-shaped curve as the lower vertebrae begin to extend and gradually cause the upper vertebrae to extend; during the final stage, the entire neck is extended due to the extension moments at both ends. (3) The in vivo environment afforded by rodent models of injury offers particular utility for linking mechanics, nociception and behavioral outcomes. Experimental findings have examined strains across the facet joint as a mechanism of whiplash injury, and suggested a capsular strain threshold or a vertebral distraction threshold for whiplash-related injury, potentially producing neck pain. (4) Injuries to the facet capsule region of the neck are a major source of post-crash pain. There are several hypotheses on how whiplash-associated injury may occur and three of these injuries are related to strains within the facet capsule connected with events early in the impact. (5) There are several possible injury criteria to correlate with the duration of symptoms during reconstructions of actual crashes. These results form the biomechanical basis for a hypothesis that the facet joint capsule is a source of neck pain and that the pain may arise from large strains in the joint capsule that will cause pain receptors to fire.

Burn-blast combined injury / 中华烧伤杂志

Burn-blast combined injury is caused by two injury factors--heat and blast, which inflict the body at the same time or in sequence. The incidence of the combined injury is high either in wartime or in peacetime, and the mortality is much higher than that of an injury due to either one injury factor. In order to elucidate the mechanism, characteristics of the injury and the treatment of the combined injury, lots of studies were carried out both at home and abroad. The paper presents the data of burn-blast injury from a part of experimental studies and some clinical experience in the past forty years. The paper may be useful to medical doctors who may treat burn-blast injury in future.

Road crash in China from 2003 to 2005 / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To analyze characteristics and causes of road crash and injuries in China from 2003 to 2005.</p><p><b>METHODS</b>The data of road crash in 2003-2005 were collected to study the characteristics including total vehicle number, occurrence rates of traffic accidents and serious traffic accidents so as to discuss the causes and characteristics of road crash in China.</p><p><b>RESULTS</b>From 2003 to 2005, the numbers of traffic accidents, injuries and deaths as well as the mortality rates per 100,000 persons and per 10,000 vehicles declined in China. Until 2005, the total number of traffic accidents decreased to 450,000 and deaths to 99,000, with the mortality rate per 10,000 vehicles being 7.6 persons. While the drivers and passengers accounted for 33.2% and 26.6% of death casualties respectively in 2005. Most traffic accidents were caused by drivers, especially those with driving experience less than 3 years. Traffic accidents occurred on suburban roads accounted for 60%. The mortality rate of the traffic accidents per 100 km on the first grade road ranked the highest. The mortality rate of the traffic accidents on expressways ranked the highest, with continual increase of death and injury.</p><p><b>CONCLUSIONS</b>At present, the increase trend of traffic accidents and casualties in China has been slowed down to some extent and shows a declining tendency, but the situation is far away from being optimistic. In order to cut down the number of traffic accidents and casualties, we should pay more attention to training and managing drivers with less than three driving years and those driving buses. Strict prevention measures should be laid on traffic accidents on first grade roads, expressways and suburban roads as well as the enhancement on improving first-aid system.</p>

Vascular endothelial growth factor and its receptor expression during the process of fracture healing / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the expression regularity of vascular endothelial growth factor (VEGF) during the process of fracture healing, and the type of VEGF receptor expressed in the vascular endothelial cells of the fracture site.</p><p><b>METHODS</b>The fracture model was made in the middle part of left radius in 35 rabbits. The specimens from the fracture site were harvested at 8, 24, 72 hours and 1, 3, 5, 8 weeks, and then fixed, decalcified, and sectioned frozenly to detect the expression of VEGF and its receptor at the fracture site by in situ hybridization and immunochemical assays.</p><p><b>RESULTS</b>VEGF mRNA and VEGF expression was detected in many kinds of cells at the fracture site during 8 hours to 8 weeks after fracture. Flt1 receptor of VEGF was found in the vascular endothelial cells at the fracture site during 8 hours to 8 weeks after fracture, and strong expression of flk1 receptor was detected from 3 days to 3 weeks after fracture.</p><p><b>CONCLUSIONS</b>The expression of VEGF and flt1 receptor appears during the whole course of fracture healing, especially from 1 to 3 weeks. Flk1 receptor is highly expressed in a definite period after fracture. VEGF is proved to be involved in the vascular reconstruction and fracture healing.</p>

Motorcycle accidents in China / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To analyze the characteristics and causes of motorcycle accidents in China from 2000 to 2005.</p><p><b>METHODS</b>We collected data on possession of motorcycles and automobiles, number of traffic crashes, casualty and economic loss from 2000-2005 Statistic Annual Report of Traffic Management Bureau, Ministry of Public Security of China. The data was processed statistically by SPSS 11.0 software package.</p><p><b>RESULTS</b>During 6 years, the number of motorcycle accidents were up to 122,300 in 2003, which was the highest, and then gradually decreased. However, the casualty had the tendency of consistent increase, for example, the motorcycle accidents resulted in 26,200 deaths and 157,500 injuries in 2005. The mortality per 10, 000 motorcycles and the ratio of deaths to injuries were lower than those of automobiles, but the mortality per 100 motorcycle accidents was significantly higher than that of automobiles (P less than 0.01).</p><p><b>CONCLUSIONS</b>China has attached great importance to the management of traffic safety, which is beneficial to control and reduce traffic accidents in recent years. However, the casualty keeps increasing annually. Therefore, it is urgent to strengthen the management of motorcycles, promote the education of motorcyclists, take effective traffic measures and improve the first-aid system of traffic injuries.</p>

Regulation of vascular endothelial growth factor on the expression of fracture healing-related factors / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the effect of vascular endothelial growth factor (VEGF)and anti-VEGF on the expression of fracture healing-related factors and observe pathological changes at fractured sites.</p><p><b>METHODS</b>Fracture models were established in 105 New Zealand white rabbits and they were randomly divided into control group, VEGF group and anti-VEGF group. The relevant factors expression at fractured sites was assayed and pathological changes were observed in decalcified samples at 8, 24, 72 hours and 1,3,5,8 weeks after fracture.</p><p><b>RESULTS</b>After application of VEGF, the expression of BMP appeared earlier and expression time lasted longer. On the contrary, anti-VEGF completely inhibited the expression of BMP. The fractured sites were filled with fibrous callus, cartilaginous callus and bony callus at the 3rd week and woven bone was constructed at the 5th week. Fracture healing was accomplished at the 8th week in VEGF group. In anti-VEGF polyclonal antibody group, cellular necrosis increased at early period. Continuous focal necrosis was seen in the fractured sites from the 1st week to 5th week. Vascularization reduced obviously at the 3rd week.</p><p><b>CONCLUSIONS</b>Fracture healing is a result of mutual regulation and coordination among many factors. VEGF may be an important factor in fracture healing.</p>