Epidemiology and Assessment of Traumatic Spinal Cord Injury With Concomitant Brain Injury: An Observational Study in a Regional Trauma Center.

OBJECTIVE: : To analyze the epidemiological information of patients with traumatic spinal cord injury (SCI) and concomitant traumatic brain injury (TBI) and to suggest points to be aware of during the initial physical examination of patients with SCI. METHODS: : This study was a retrospective, observational study conducted in a regional trauma center. All the records of patients diagnosed with traumatic SCI between 2016 and 2020 were reviewed. A total of 627 patients with confirmed traumatic SCI were hospitalized. A retrospective study was conducted on 363 individuals. RESULTS: : The epidemiological data of 363 individuals were investigated. Changes in American Spinal Injury Association Impairment Scale (AIS) scores in patients with SCI were evaluated. The initial evaluation was performed on average 11 days after the injury, and a follow-up examination was performed 43 days after. Fourteen of the 24 patients identified as having AIS A and SCI with concomitant TBI in the initial evaluation showed neurologic level of injury (NLI) recovery with AIS B or more. The conversion rate in patients with SCI and concomitant TBI exceeded that reported in previous studies in individuals with SCI. CONCLUSIONS: : Physical, cognitive, and emotional impairments caused by TBI present significant challenges in rehabilitating patients with SCI. In this study, the influence of concomitant TBI lesions could have caused the initial AIS assessment to be incorrect.

Investigation of Newly Developed PCM/SiC Composite Aggregate to Improve Residual Performance after Exposure to High Temperature.

High temperature conditions, such as fire, are detrimental factors to the mechanical and chemical properties of concrete. In this paper, the authors developed a new type of coarse aggregate, named PCM/SiC composite aggregate (enhanced aggregate: EA), to improve fire-resistance performance. To investigate the validity of EA for construction materials, a compressive strength test, static modulus of elasticity, X-ray diffraction (XRD), and scanning electron microscopy (SEM) were conducted. In addition, this EA has been developed to improve residual performance after exposure to high temperature, with residual compressive strength and internal temperature measurement tested at 1000 °C. Furthermore, chemical properties after heating were investigated by XRD and SEM-EDAX. The results show that the percentage of residual compressive strength of heated concrete with EA is higher than plain concrete. The concrete with EA exhibited primary cement composites such as C-H and C-S-H after exposure to high temperature through XRD and SEM-EDAX. On the other hand, major hydration products could not be observed in plain concrete. PCM and SiC offer an opportunity to delay the increase in concrete temperature. From evaluation of the results, we can see that EA enhanced the residual performance of concrete after exposure to high temperature conditions.

Effects of Thermal Conductive Materials on the Freeze-Thaw Resistance of Concrete.

To solve the problem of black ice, many studies are being carried out. The key in recent days is enhancing the thermal conductivity of concrete. In this study, to improve the thermal conductivity, silicon carbide was used to substitute 50% and 100% of the fine aggregate. In addition, steel fiber is not only for enhancing the mechanical properties but could enhance thermal conductive material. Hence, the arched-type steel fiber was used up to a 1% volume fraction in this study. Furthermore, graphite was used for 5% of the volume fraction for enhancing the thermal conductivity. However, thermal damage would occur due to the difference in thermal conductivity between materials. Therefore, the thermal durability must be verified first. The target application of the concrete in this study was its use as road paving material. To evaluate the thermal durability, freeze-thaw and rapid cyclic thermal attacks were performed. The thermal conductivity of the specimens was increased with the increase in thermal conductive materials. Graphite has already been reported to have a negative effect on mechanical properties, and the results showed that this was the case. However, the steel fiber compensated for the negative effect of graphite, and the silicon carbide provided a filler effect. Graphite also had a negative effect on the freeze-thaw and rapid cyclic thermal attack, but the steel fiber compensated for the reduction in thermal durability. The silicon carbide also helped to improve the thermal durability in the same way as steel fiber. Comprehensively, the steel fiber enhanced all of the properties of the tests. Using 100% silicon carbide was considered the acceptable range, but 50% of silicon carbide was the best. Graphite decreased all the properties except for the thermal conductivity. Therefore, the content of graphite or using other conductive materials used should be carefully considered in further studies.

Evaluation of the Hydration Characteristics and Anti-Washout Resistance of Non-Dispersible Underwater Concrete with Nano-SiO2 and MgO.

In this paper, the effect of nano-SiO2 (NS) and MgO on the hydration characteristics and anti-washout resistance of non-dispersible underwater concrete (UWC) was evaluated. A slump flow test, a viscosity test, and setting time measurement were conducted to identify the impacts of NS and MgO on the rheological properties of UWC. The pH and turbidity were measured to investigate the anti-washout performance of UWC mixes. To analyze the hydration characteristics and mechanical properties, hydration heat analysis, a compressive strength test, and thermogravimetric analyses were conducted. The experimental results showed that the fine particles of NS and MgO reduced slump flow, increased viscosity, and enhanced the anti-washout resistance of UWC. In addition, both NS and MgO shortened the initial and final setting times, and the replacement of MgO specimens slightly prolonged the setting time. NS accelerated the peak time and increased the peak temperature, and MgO delayed the hydration process and reduced the temperature due to the formation of brucite. The compressive results showed that NS improved the compressive strength of the UWC, and MgO slightly decreased the strength. The addition of NS also resulted in the formation of extra C-S-H, and the replacement of MgO caused the generation of a hydrotalcite phase.

Identification of acquired tracheoesophageal fistula after tracheostomy decannulation by videofluoroscopic swallowing study: A case report.

RATIONALE: Videofluoroscopic swallowing study (VFSS) is a noninvasive radiographic procedure that examines the oral, pharyngeal, and cervical esophageal stages of swallowing. Tracheoesophageal fistula (TEF) is difficult to diagnose depending on its size and location. However, how VFSS can be of benefit in the diagnosis of TEF has not been reported yet. PATIENT CONCERNS: A 64-year-old man who had been tracheostomized post spinal tumor resection surgery at the cervical level 1 to 2, had his tracheostomy tube removed approximately 25 years ago. After decannulation, he reported coughing while swallowing food, foreign sensation in the neck and repeated bouts of pneumonia ever since. DIAGNOSIS: VFSS revealed, for the first time, acquired TEF after tracheostomy decannulation as the cause of repetitive aspiration pneumonia. INTERVENTION: VFSS was performed in this case. OUTCOMES: In the background of suspected TEF based on VFSS results, the patient underwent a computed tomography scan of the chest and airway in the prone position, followed by bronchoscopy, which confirmed the existence of a TEF. He then underwent primary closure of the fistula. The patient had an uneventful recovery and is currently symptom-free 10 months after the surgery. LESSONS: This case alerts clinicians to the possibility of TEF as a diagnosis when the aspirate leaks from the upper esophagus and through the posterior wall of trachea in the esophageal phase of VFSS.

GSTM1 and TNF-alpha gene polymorphisms and relations between blood lead and inflammatory markers in a non-occupational population.

Inflammation is known to be an important underlying condition in the development of a variety of diseases. To investigate whether blood lead induces inflammatory reactions in non-occupationally exposed adults and the effects of genetic susceptibility associated with GSTM1 and TNF-alpha gene polymorphisms on this inflammatory response, we measured blood lead levels in 300 healthy university students. Total serum TNF-alpha and IL-6 levels and WBC counts were determined to evaluate the inflammatory response. Allelic loss of GSTM1 and the TNF-alpha-308 G>A polymorphism were determined by PCR and RFLP. Positive relations between blood lead and three inflammation biomarkers were shown in male subjects with blood lead > or =2.51microg/dl (median value) (TNF-alpha, p=0.015; IL-6, p=0.082; and WBC, p=0.044). However, subgroup analysis by genotype showed an effect of blood lead on the three biomarkers only in individuals with the GSTM1 null (TNF-alpha, p=0.020; IL-6, p=0.096; and WBC, p=0.017) or TNF-alpha GG (TNF-alpha, p=0.017; IL-6, p=0.088; and WBC, p=0.095) genotype, and not in individuals with GSTM1 present (all three inflammatory biomarkers, p>0.1) or the TNF-alpha GA or AA (all three biomarkers, p>0.1) genotype. These results suggest that blood lead affects the inflammatory response and that GSTM1 and TNF-alpha gene polymorphisms are genetic factors associated with lead-induced inflammatory response.

Effect of short-term fasting on urinary excretion of primary lipid peroxidation products and on markers of oxidative DNA damage in healthy women.

The goal of this study was to determine whether short-term fasting changes in urinary biomarkers related to oxidative stress: malondialdehyde (MDA), 8-isoprostaglandin F2alpha (8-isoPGF), 8-hydroxydeoxy-guanosine (8-OHdG) and 1,N6-ethenodeoxyadenosine (epsilondA) among female volunteers participating in the short-term fasting program in South Korea. The study subjects were 52 healthy women (mean age 28, range 15-48 years old) who provided urine samples both before and after the fasting program (average 7.2, range: 3-11 days). Urinary MDA was measured by HPLC-UV and epsilondA levels were measured by immuno-affinity purification followed by HPLC-fluorescence detection. Urinary 8-OHdG and 8-isoPGF concentrations were determined by ELISA. Plasma leptin levels were also measured by radioimmunoassay. Information on demographic characteristics, personal habits (smoking and alcohol consumption) and previous medical history were collected by a self-administered questionnaire. Percent loss of body weight (average 6.3%, 4.28 +/- 0.25 kg) was significantly correlated with fasting duration (r = 0.70, n = 52, P < 0.01). The plasma leptin levels after fasting (5.89 +/- 1.10 ng/ml) were significantly lower than before fasting (6.91 +/- 1.13 ng/ml) (n = 27, P = 0.05). Urinary MDA levels after fasting (0.18 +/- 1.10 mg/g creatinine) were significantly lower than before fasting (0.37 +/- 1.11) (n = 51, P < 0.01). Urinary 8-isoPGF also were significantly reduced after fasting (n = 47, P < 0.01). However, there was no significant difference in 8-OHdG or epsilondA. There was a statistically significant correlation between % change of urinary MDA level with % change of 8-isoPGF level (partial correlation coefficient r = 0.57, n = 46, P = 0.01). The correlations between % change of 8-OHdG and plasma leptin was also significant (partial correlation coefficient r = 0.51, n = 27, P = 0.02). Our results demonstrate that the short-term fasting reduces lipid peroxidation products but does not affect oxidative stress-induced DNA damage.