Wounding characteristics and treatment principles of ground anti-armored vehicle ammunition against armored crew.

The wound mechanism, injury characteristics and treatment principles of anti-armored vehicle ammunition against armored crew in the past 20 years are summarized in this paper. Shock vibration, metal jet, depleted uranium aerosol and post armor breaking effect are the main factors for wounding armored crew. Their prominent characteristics are severe injury, high incidence of bone fracture, high rate of depleted uranium injury, and high incidence of multiple/combined injuries. During the treatment, attention must be paid on that the space of armored vehicle is limited, and the casualties should be moved outside of the cabin for comprehensive treatment. Especially, the management of depleted uranium injury and burn/inhalation injury are more important than other injuries for the armored wounds.

Establishment of a novel rat model of blast-related diffuse axonal injury.

Although studies concerning blast-related traumatic brain injury (bTBI) have demonstrated the significance of diffuse axonal injury (DAI), no standard models for this type of injury have been widely accepted. The present study investigated a mechanism of inducing DAI through real blast injury, which was achieved by performing instantaneous high-speed swinging of the rat head, thus establishing a stable animal model of blast DAI. Adult Sprague-Dawley rats weighing 150±10 g were randomly divided into experimental (n=16), control (n=10) and sham control (n=6) groups. The frontal, parietal and occipital cortex of the rats in the experimental group were exposed, whereas those of the control group were unexposed; the sham control group rats were anesthetized and attached to the craniocerebral blast device without experiencing a blast. The rats were subjected to craniocerebral blast injury through a blast equivalent to 400 mg of trinitrotoluene using an electric detonator. Biomechanical parameters, and physical and behavioural changes of the sagittal head swing were measured using a high-speed camera. Magnetic resonance imaging (MRI) scans were conducted at 2, 12, 24 and 48 h after craniocerebral injury, only the experimental group indicated brain stem injury. The rats were sacrificed immediately following the MRI at 48 h for pathological examination of the brain stem using haematoxylin and eosin staining. The results indicated that 14 rats (87.5%) in the experimental group exhibited blast DAI, while no DAI was observed in the control and sham control groups, and the difference between the groups was significant (P<0.05). The present results indicated that this experimental design may serve to provide a stable model of blast DAI in rats.

An open air research study of blast-induced traumatic brain injury to goats.

PURPOSE: We once reported blast-induced traumatic brain injury (bTBI) in confined space. Here, bTBI was studied again on goats in the open air using 3.0 kg trinitrotoluene. METHODS: The goats were placed at 2, 4, 6 and 8 m far from explosion center. Trinitrotoluene (TNT) was used as the source of the blast wave and the pressure at each distance was recorded. The systemic physiology, electroencephalogram, serum level of S-100 beta, and neuron specific enolase (NSE) were determined pre and post the exposure. Neuroanatomy and neuropathology were observed 4 h after the exposure. RESULTS: Simple blast waveforms were recorded with parameters of 702.8 kPa-0.442 ms, 148.4 kPa-2.503 ms, 73.9 kPa-3.233 ms, and 41.9 kPa-5.898 ms at 2, 4, 6 and 8 m respectively. Encephalic blast overpressure was on the first time recorded in the literature by us at 104.2 kPa-0.60 ms at 2 m, where mortality and burn rate were 44% and 44%. Gross examination showed that bTBI was mainly manifested as congestive expansion of blood vessels and subarachnoid hemorrhage, which had a total incidence of 25% and 19% in 36 goats. Microscopical observation found that the main pathohistological changes were enlarged perivascular space (21/36, 58%), small hemorrhages (9/36, 25%), vascular dilatation and congestion (8/36, 22%), and less subarachnoid hemorrhage (2/36, 6%). After explosion, serum levels of S-100b and NSE were elevated, and EEG changed into slow frequency with declined amplitude. The results indicated that severity and incidence of bTBI is related to the intensity of blast overpressure. CONCLUSION: Blast wave can pass through the skull to directly injure brain tissue.

Clinical relevance of tag single nucleotide polymorphisms within the CAT gene in patients with PTSD in the Chongqing Han population.

BACKGROUND: Free radical-induced oxidative damage of the brain has been implicated in a number of psychiatric disorders, including post-traumatic stress disorder (PTSD). Catalase (CAT) is a major antioxidant enzyme and a number of polymorphisms in CAT have been shown to be associated with several diseases, including hypertension, diabetes mellitus, Alzheimer's disease, and vitiligo. The aim of this study was to evaluate the association of CAT gene polymorphisms with PTSD in a case-control study. MATERIALS AND METHODS: A total of 460 unrelated adult Chinese Han adults, including 287 healthy volunteers and 173 patients with PTSD. Six tag single-nucleotide polymorphisms (tSNPs) were selected from the entire CAT gene through construction of haplotype bins, and they were genotyped using an improved multiplex ligation detection reaction (iMLDR) technique. Allelic frequencies and clinical characteristics were compared in two independent Chinese Han populations. RESULTS: Six tag SNPs were identified in the Chinese Han population and all were common SNPs. However, we could detect no evidence of genetic association between six tag SNPs in the CAT gene and PTSD in the Chinese Han population. CONCLUSIONS: This result suggests that six tag SNPs of the CAT gene may not be associated with PTSD, and that CAT gene might not influence the development of PTSD in patients following exposure to a traumatic event, also may be the sample sizes too small to allow a meaningful test.

Blast-induced traumatic brain injury of goats in confined space.

OBJECTIVE: To study blast-induced traumatic brain injury (bTBI) characteristics in confined space. METHODS: The goats were placed at the column-like buildings with trinitrotoluene (TNT) as the source of the blast wave. The pressure was recorded at 2-8 m from the explosion center. The systemic physiology, electroencephalogram (EEG), serum level of S-100beta, and neuron specific enolase (NSE) were determined pre and post the exposure. Neuroanatomy and neuropathology were observed 4 hours after the exposure. RESULTS: The blast waveform was composed of two peaks from the incident and reflection wave with a range of pressure-duration from 555/913 kPa-0.663 milliseconds at 2 m to 45/71 kPa-2.7/2.367 milliseconds at 8 m. At 2 m, the goats experienced brain depression while the heart rate and respiratory rate concomitantly increased with bloody foam fluid emission from the nose and the mouth. Of the goats, 88.89% were burned. The distinctive gross neuroanatomical changes were congestive expansion of surface vessels on the hemisphere cerebellum and brainstem along with subarachnoid hemorrhage on the frontal lobe, mesencephalon, and brainstem. Subarachnoid hemorrhage, enlarged perivascular space, vascular dilatation and congestion, and parenchymal hemorrhagic could be easily observed microscopically. High amplitude and low frequency of waveforms appeared in the EEG. The serum concentration of S-100beta and NSE were elevated. Although these pathophysiological changes diminished with increasing distance from the explosive center, these changes existed for the 8 m subjects. CONCLUSIONS: Blast-induced traumatic brain injury can be induced by a complex blast wave with a pressure and duration of 45/71 kPa and 2.7/2.367 milliseconds. Its severity is related to the features and waveforms of the blast.

Morphological study of Schwann cells remyelination in contused spinal cord of rats.

OBJECTIVE: To study the role and effect of Schwann cells (SCs) remyelination in contused spinal cord. METHODS: Green fluorescence protein expressing-SCs were transplanted into the epicenter, rostral and caudal tissues of the injury site at 1 week after the spinal cords were contused. At 6 weeks, the spinal cords were removed for cryosections, semithin sections and ultrathin sections, and then immunocytochemical staining of myelin basic protein (MBP), P0 protein (P0) and S100 protein (S100) was carried out on the cryosections. Qualitative and semiquantitative analyses were performed on the cryosections and semithin sections. Ultrastructure of myelinated fibers was observed on the ultrathin sections under electron microscope. RESULTS: Transplanted SCs and myelinated fibers immunocytochemically labeled by MBP, P0 as well as S100 distributed in whole injured area. The quantity of myelinated fibers labeled by the three myelin proteins showed no statistical difference, however, which was significantly larger than that of controls. On the semithin sections, the experimental group demonstrated more myelinated fibers in the injured area than the controls, but the fibers had smaller diameter and thinner myelin sheath under electron microscope. CONCLUSION: SCs can promote regeneration of injured nerve fibers and enhance remyelination, which may be histological basis of SCs-mediated functional repair of injured spinal cords.

Genetic distribution and association analysis of DRD2 gene polymorphisms with major depressive disorder in the Chinese Han population.

Dopamine D2 receptor is involved in reward-mediating mesocorticolimbic pathways. It plays an important role in major depressive disorder (MDD). Three gene polymorphisms Taq1A, C957T and -141C ins/del, were identified in the DRD2 gene among the Western population. These variants in the DRD2 gene might be associated with the susceptibility of MDD patients through affecting the bioeffects of endogenous dopamine neurotransmission. However, little is known about their occurrence in Chinese population and their association with the susceptibility of patients with major depressive disorder. In this study, a total of 338 unrelated adult Chinese Han population, including 224 healthy volunteers and 114 patients with major depressive disorder, were recruited. DRD2 polymorphisms (Taq1A and -141C ins/del) were detected using restriction fragment length polymorphism (RFLP) analysis and the C957T were detected by sequencing directly. As a result, three polymorphisms were identified in Chinese Han population and all were common SNP. However, we could detect no evidence of genetic association between 3 markers in DRD2 and major depressive disorder in the Chinese Han population. To conclude, this result suggests that Taq1A, C957T and -141C ins/del of DRD2 gene may not be associated with major depressive disorder, also may be the sample sizes too small to allow a meaningful test.

Differing Schwann cells and olfactory ensheathing cells behaviors, from interacting with astrocyte, produce similar improvements in contused rat spinal cord's motor function.

In recent years, cell behaviors of Schwann cells (SCs) and olfactory ensheathing cells (OECs) when interacting with astrocytes was appraised qualitatively in vitro and in spinal cord injury model of dorsal crush and transection and in normal white matter. In this study, with an attempt to select a candidate for cell-mediated repair of the spinal cord injury, SCs or OECs were transplanted into contused spinal cord in adult rats. The interaction with host astrocytes was assessed at 3 and 6 weeks after transplantation under light and electron microscope. The motor function of the rat was appraised with the BBB locomotor rating scale and cortical somatosensory evoked potentials (CSEP) recording. Within SCs cord, the astrocytes underwent proliferation and hypertrophy. The myelinated axons were separated into the groups by the glial membrane. Within OECs cord, astrocytes did not undergo the proliferation and hypertrophy. The myelinated axons were not divided into groups by the scar tissue. SCs graft, compared with OECs graft, induced more enhanced glial fibrillary acidic protein (GFAP) immunoreactivity with a distinct astroglial border between the normal and injured tissues. The distribution of SCs was more concentrated and less migrated than that of OECs. SCs induced weaker NF immunoreactivity and functional recovery compared to OECs, but no significant differences between the two groups was revealed by the statistical analysis. As we know, this is first time to compare behaviors of SCs and OECs in the contusion model, and the data indicates that although in vivo cell behaviors of SCs and OECs are different in interacting with astrocyte, both cell types can improve the motor function of the contused rats.

Olfactory ensheathing cells can reduce the tissue loss but not the cavity formation in contused spinal cord of rats.

In recent years, olfactory ensheathing cells (OECs) have been used as a therapeutic strategy to repair the anatomical structure and promote the function recovery of injured spinal cord in both animal and human. In this study, OECs were transplanted into contused spinal cords of adult rats. After dorsal laminectomy at T10 vertebra, spinal cord was injured by a force of 10 g with NYU II impactor from 25 mm above the exposed cord. The contused spinal cord received injections of OECs in DMEM or DMEM alone at one week after injury. The migration and distribution of OECs in the contused spinal cord were observed by the light microscope. The intact tissue area, injured tissue area, cavity size, number of myelinated nerve fibers and neurons labeled by CB-HRP in T8 segment were measured and counted by the semi-quantitative techniques at 6 weeks after transplantation. Locomotor ability and conductive function of the spinal cord were evaluated by the BBB score and cortical somatosensory evoked potentials (CSEP) recording. OECs were found in both lesion site and tissue near the lesion. The intact tissue area was significantly larger in the OECs-transplanted rats than that in the DMEM-injected animals, whereas the injured tissue area was significantly smaller in the OECs-rats than that in the DMEM-rats. The number of myelinated nerve fibers in the lesion site and preserved neurons in T8 was significantly greater in the OECs-group than in the DMEM-group, but the cavity size detected was not significantly different between the two groups. The BBB score and CSEP recording showed a better performance of locomotor ability and conductive function in the OECs-transplanted rats than in the DMEM-injected animals. These results indicate that OECs can counteract secondary tissue degeneration after spinal cord injury. Although they cannot reduce the cavity formation, they can promote morphological preservation and functional improvement of the contused spinal cord.

Olfactory ensheathing cells enhance Schwann cell-mediated anatomical and functional repair after sciatic nerve injury in adult rats.

Sciatic nerve injury results in axon damage, muscle degeneration, and loss of function. We compared the potential of Schwann cell (SC), olfactory ensheathing cell (OEC), or mixed SC/OEC transplants for anatomical and functional restoration after adult rat sciatic nerve transection. The cells were seeded into a 20mm long macroporous poly(dl-lactide-co-glycolide) acid conduit and grafted between the sciatic nerve stumps. Some rats received a conduit without cells (controls) or an autologous nerve graft, the clinical standard of care. Compared with SC transplants, axon regeneration was 25% less with OEC transplants but 28% more with SC/OEC transplants. Gastrocnemius muscle restoration was similar with a SC or OEC transplant and 35% better with a SC/OEC transplant. With SC transplants, motor and sensory function recovery and electrophysiological outcomes were similar as with OEC transplants and 33% better with SC/OEC transplants. Compared with the mixed SC/OEC transplants, axon regeneration was 21% better and gastrocnemius muscle restoration was 18% better with autologous peripheral nerve transplants, but these improvements did not translate into increased function and electrophysiological outcomes. Our results revealed that OEC synergistically improve SC mediated sciatic nerve repair. The data emphasized the promise of SC/OEC transplants as artificial nerves for peripheral nerve repair. This article is part of a Special Issue entitled: Understanding olfactory ensheathing glia and their prospect for nervous system repair.

Survival and number of olfactory ensheathing cells transplanted in contused spinal cord of rats.

OBJECTIVE: To observe the survival and the number of olfactory ensheathing cells (OECs) transplanted in the contused spinal cord, so as to provide a basis for further studying the biological action of OECs. METHODS: The rat spinal cords were contused with NYU-impactor II at T10 level by dropping a 10 g rod from a height of 25 mm. At the 1st week after injury, OECs isolated freshly from green fluorecense protein (GFP) of the rats were transplanted into the spinal cord at injured site and other two sites 1 mm apart from the caudal and rostral ends with the OECs number of 30000/µl x 3 = 90000. The survival and the number of OECs were qualitatively and semi-quantitatively observed under the fluorescense microscope from 1 week to 13 weeks after transplantation. The motor function of the cord was evaluated with BBB score. RESULTS: GFP-OECs could survive at least for 13 weeks within the contused spinal cord. Their arrangement was from tight to loose and their number was decreased from 1 week to 13 weeks after injury. The average number of GFP-OECs was 536 at the 1st week, which was less than 1% of the number as compared with original transplantation. After then, the number of GFP-OECs was continually decreased, but the most obvious decrease was found during 1 week to 2 weeks. The extent of decrease at other time points was relatively mild. In contrast to the cell number, motor function of the cord was gradually recovered after transplantation. CONCLUSIONS: The survival and the number of GFP-OECs are different between the animals and are affected by the pathological reaction of the host cord. Also it is related to the motor function recovery of the contused cord.

PLGA conduit seeded with olfactory ensheathing cells for bridging sciatic nerve defect of rats.

PLGA is thought to be a promising material for nerve scaffold. OECs have been shown to promote axon outgrowth and myelination following peripheral nerve transection. This study assessed the compatibility between PLGA and OECs in vitro, and evaluated the effect of PLGA conduit filled with OECs and extracellular matrix gel (ECM) (POE group) on 10 mm-defect sciatic nerve of rats. Silicon-OECs-EMC (SOE group), PLGA-ECM (PE group), and silicon-ECM (SE group)-were used as the controls. The survival and distribution of OECs in vivo, neurohistology and neurofunction of the bridged nerve, were quantitatively evaluated from 1 week to 12 weeks after surgery. PLGA possessed complete compatibility with OECs. After implantation, OECs migrated along the axis of the nerve and survived longer in the POE group than in the SOE group. Gross recovery of the animal, like ulcerious and autophagical rate as well as relative diameter recovery rate of the fiber, was more successful in the POE group than in other groups. The number of the fiber in the middle and distal segments of bridged sites and neurons in anterior horn of the spinal cord was increased in both OECs-contained groups, but the diameter and the myeline thickness of the fiber were increased only in the POE group. The nerve conduction velocity and the amplitude of compound muscle active potential were improved much successfully in the PLGA-guided group than in the silicon-guided group, but the best improvement was encountered in the POE group. Sciatic function index was not improved in all groups at 12 weeks after surgery due to the injury model. These results suggested that PLGA filled with OECs is a significant alternative to conventional autograft in repairing peripheral nerve defects, and OECs are potential seed cells for peripheral nerve tissue engineering.

Treatment of rabbit femoral defect by firearm with BMP-4 gene combined with TGF-beta1.

BACKGROUND: Firearm bone fractures are difficult to treat compared with general ones as both soft tissue and bone are injured more extensively and severely with contamination in the wound track. The bone morphogenetic protein (BMP) and transforming growth factor (TGF)-beta play an important role in bone fracture healing. Therefore, BMP-4 combined with TGF-beta1 was used to improve and accelerate the repair of rabbit femoral defect resulting from firearm. METHODS: Femoral defect was made with 0.375 g steel ball fired at 350 m/s. At 6 hours after wounding, the debridement and irrigation were performed, followed by trimming the ends of defected bone at day 7. Plasmid-encoded BMP-4 gene identified in vitro and TGF-beta1 were injected into the tissue of upper and lower parts and the epicenter of the defected area at 2 weeks after wounding, again TGF-beta1 was given at 5 weeks. At 3, 7, 11, and 15 weeks after wounding, the expression of mRNA and protein of BMP-4 were detected by reverse transcription-polymerase chain reaction and Western blot. The activity of alkaline phosphatase and calcium content were measured for describing osteogenetic ability. The course and quality of osteogenesis were determined quantitatively by pathohistological and X-ray examinations. RESULTS: In vivo BMP-4 mRNA and protein could be continually expressed for 8 weeks. The determination of alkaline phosphatase activity and calcium content showed osteogenetic ability was significantly enhanced by BMP-4 gene combined with TGF-beta1. The pathohistological and X-ray examinations revealed that osteogenetic speed was prominently accelerated, and the quality was improved after the treatment. CONCLUSION: The repair of rabbit femoral defect resulting from firearm can be significantly improved and accelerated by BMP-4 gene combined with TGF-beta1.

Cell death-inducing DFF45-like effector may take part in neuronal apoptosis of the lumbar spinal cord after sciatic nerve injury caused by a firearm.

OBJECTIVE: To investigate neuronal apoptosis and gene regulation after peripheral nerve injury caused by a firearm. METHODS: A rabbit model of sciatic nerve injury caused by a firearm was used. Neuronal apoptosis was determined by using terminal transferase-mediated dUTP nick end-labeling and flow cytometry. Differentially expressed genes were screened with mouse_8192S GeneChips. Cell death-inducing DFF45-like effector (CIDE-B) gene expression in spinal cord after sciatic nerve injury was detected with reverse transcription-polymerase chain reaction. RESULTS: The size of the injury caused by the firearm was widely extended. Neuronal apoptosis was found in days 1, 3, and 7 groups. The expression of apoptosis-related gene CIDE-B was high according to analysis of the GeneChips and reverse transcription-polymerase chain reaction detection. The trend of CIDE-B expression was consistent with neuronal apoptosis after nerve injury. CONCLUSIONS: Neuronal apoptosis is an important pathological change after peripheral nerve injury caused by firearms, and CIDE-B may be an important regulator.

Identification of differentially expressed genes from spinal cord after firearm injury to rabbit sciatic nerves.

OBJECTIVE: Peripheral nerve regeneration depends on gene regulation by central neurons. To search for more effective treatment methods to improve the regeneration of wounded peripheral nerves, gene expression profile of spinal cord after firearm injury to rabbit sciatic nerves are studied with DNA micro-array technique. METHODS: A total of 54 rabbits were randomly divided into 4 groups: Groups d1, d3, d7 and normal control group. Lumbar spinal cords were sampled. RNA and mRNA were extracted, labeled by Cy3 and Cy5, and analyzed by mouse_8192S gene chips. RESULTS: A total of 1367, 923, and 61 genes with differential expression were found on day 1, day 3, and day 7 after trauma respectively. Five expressed sequence tag (EST) sequences demonstrated differential expression during 7 days after trauma. CONCLUSIONS: There is complex gene profile with differential expression after firearm nerve injury, among which AW701496, U84291, W13926, X04017 and AW822394 EST sequences may be important regulation factors that involved in regeneration of peripheral nerve injury.