Wounding characteristics and treatment principles of ground anti-armored vehicle ammunition against armored crew / 中华创伤杂志(英文版)

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.

An open air research study of blast-induced traumatic brain injury to goats / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSION</b>Blast wave can pass through the skull to directly injure brain tissue.</p>

Morphological study of Schwann cells remyelination in contused spinal cord of rats / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the role and effect of Schwann cells (SCs) remyelination in contused spinal cord.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSION</b>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.</p>

Hyperbaric oxygen therapy in rabbits after explosive brain injury: a MRS and DWI study / 中华神经医学杂志

Objective To evaluate the role of magnetic resonance spectroscopy (MRS) and diffusion-weighted MRI (DWI) in detecting regional cerebral metabolic changes and changes of water molecular motion in rabbits after explosive brain injury at different time points of injury after being treated with hyperbaric oxygen therapy. Methods Ninety New Zealand white rabbits were divided into control group, trauma group and hyperbaric oxygen treatment group. The injured models in the later 2 groups were established using 600 mg TNT equivalent of paper detonators in the rabbit brain at the top of 6.5 cm vertical distance. Rabbits in the trauma group and hyperbaric oxygen treatment group were sub-divided into 1, 3, 7, 14 and 21 d treatment groups, respectively. The survival of these rabbits was observed at these time points. Hyperbaric oxygen treatments lasting for 1, 3, 7, 14 and 21 d were given to each hyperbaric oxygen treatment sub-groups, respectively. Performance under MRS was detected and dynamic changes of N-acetylaspartate (NAA)/creatine (Cr) ratio and NAA/choline(Cho)+Cr value were observed with MRS. DWI was employed to detect the dynamic changes of apparent diffusion coefficient (ADC) values. Results The NAA/Cr ratio in the trauma group markedly decreased right after the injury and slightly rose 7 d after the injury. Compared with that in the trauma group, the NAA/Cr ratio in the hyperbaric oxygen treatment group was significantly increased (P＜0.05). The NAA/Cho+Cr value in the trauma group was markedly decreased right after the injury, while that in the hyperbaric oxygen treatment group was obviously increased as compared with that in the trauma group (P＜0.05). ADC values in the region of interest of the trauma group was decreased after 1 d of treatment and gradually increased after 3 d of treatment; the ADC values in the hyperbaric oxygen treatment group was obviously higher than those in the trauma group (P＜0.05). Conclusion Hyperbaric oxygen might improve the prognosis by improving local metabolism of neurons, inhibiting brain edema, and enhancing local gliosis repair;, ultra-early intervention (within one week of injury) may be much favorable for animals/patients after explosive brain injury.

Survival and number of olfactory ensheathing cells transplanted in contused spinal cord of rats / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSIONS</b>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.</p>

Culture and morphologic characteristics of olfactory ensheathing cells isolated from young adult GFP rat / 中华神经医学杂志

Objective To establish methods for isolating and culturing the olfactory ensheathing cells (OECs) from young adult GIT rat to lay the foundation for repair of the spinal cord injury.Methods The OECs were dissociated from the first outer layer of the olfactory bulb of the young adult GFP rat (2.5 months old) under anatomical microscope; enzymatic digestion was performed on these cells and then they were inoculated into DMEM/F12 with 20% fetal calf serum. The morphology of OECs was regularly observed and photographied under light and electronic microscope. On the 10th culture day, the OECs were identified by the immunocytochemistry staining of S-100 and NGFRp75 and the purity (the positive rate) was calculated. Results The OECs showed strong green fluorescence under fluorescent microscope and presented morphological types of bipolar and bearing multipolar. More than 95% of the cultured cells were identified to be OECs, which expressed S-100 and NGFR p75. The cell structure revealed by electron microscope was much accordance with that by light microscope. Conclusion This method is easy to perform and high purity of GFP-OECs can be harvested with the same morphological characteristics and biological activity as general OECs. Therefore, OECs derived from the GFP transgenic rat can be effective tool cells, and widely used in studying the role of OECs in the repair of spinal cord injury

Effect of hyperbaric oxygen on the changes of autophagy and apoptosis in cerebral cortex in rats with brain explosive injury / 中华神经医学杂志

Objective To observe the changes of autophagy and apoptosis in the cerebral cortex in rats with brain explosive injury and received hyperbaric oxygen (HBO) treatment, and investigate the effect and significance of HBO on them. Methods Fifty-four SD rats were randomly divided into control group (n=6), explosive injury group (n=24) and explosive injury treated with HBO group (n=24).The control group was not injured and 600 mg TNT electric detonators were exploded over the brain of rats at a 12 cm distance in the explosive injury group and explosive injury treated with HBO group. HBO management was given to the explosive injury treated with HBO group 3 and 22 h after explosive injury and at the same time of the other 6 d. RT-PCR and Western blotting were used to detect the changes of Beclin-1 and caspase-3 in the cerebral cortex on the 6th and 24th h, 3rd and 7th d of injury. Results The expression levels of Beclin-1 and caspase-3 in the explosive injury group and explosive injury treated with HBO group were obviously higher than those in the control group (P＜0.05). The levels of Beclin-1and caspase-3 in the explosive injury treated with HBO group were significantly lower than those in the explosive injury group at the same time points (P＜0.05). Conclusion The decreased expressions of autophagy and apoptosis in brain cells by HBO treatment might be one of the possible mechanisms of treating craniocerebral injury.

Identification of differentially expressed genes from spinal cord after firearm injury to rabbit sciatic nerves / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSIONS</b>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.</p>

Study on the evaluation of the execution of super high velocity fragment / 第三军医大学学报

Objective　To provide experimental basis for the weapon design by means of observing the injury by super high velocity fragments. Methods　Nine male Huanan dogs were wounded by super high velocity aluminium bullet shot from an explosive gun with the energy of 15 360,12 643 and 8 144 J respectively, the degree of injury of local tissues and the pathological changes of main organs were observed. Results　The injury degree of local tissue wounded by the super high velocity fragment of 15 360 J was similar to that of 8 144 J, and was more severe than that of wound by 12 643 J. Conclusion　The injury degree is closely related to the mass and the momentum of the super high velocity fragment, the more the momentum is,the greater the execution is. No significant relationship exist between the injury degree and the energy.

Observation on the craniocerebral injury of sheep by high explosive shell / 第三军医大学学报

Objective　To observe the characteristics and rules of craniocerebral injury resulting from a high explosive shell to provide the bases for treating explosive injury. Methods　A total of 36 sheep were distributed at the distance 6 to 48 m away from the explosive center and the shell was exploded electrically at 7 m above the earth. At the same time, the velocity of fragments and shock wave pressure were determined. Gross and pathological observations were performed after injury. Results　Among all sheep with fragment injury, craniocerebral injury was 32%. Their immediate death rate was 75% and all died 6 h later. The incidence rates of penetrating wound and blind wound were 75% and 25% respectively. Pollution of wound track was heavy. The percentage of head lost was 50% in sheep and 50% of injured animal suffered from comminuted fracture of skull base. Bleeding was found extensively on the surface of the cerebrum, even medulla oblongata was involved. Hemorrhage, edema, rupture of small blood vessels and degeneration of neuron were found at the regions 4 cm away from the wound tract with light microscopy. Combined blast injury was found and occurred most often in the abdomen and limbs, both accounting for 62.5%, and combined thoracic injury was the third, up to 50%. All the animals of craniocerebral injury combined with lung blast injury. Conclusion　High explosive shells destroy cranium badly and extensively. Many skulls are lost and the cranial base is readily fractured. The wound track is heavily polluted. Combined injury is more often occurred.

Study on the evaluation of the execution of super high velocity fragment / 第三军医大学学报

Objective　To provide experimental basis for the weapon design by means of observing the injury by super high velocity fragments. Methods　Nine male Huanan dogs were wounded by super high velocity aluminium bullet shot from an explosive gun with the energy of 15 360,12 643 and 8 144 J respectively, the degree of injury of local tissues and the pathological changes of main organs were observed. Results　The injury degree of local tissue wounded by the super high velocity fragment of 15 360 J was similar to that of 8 144 J, and was more severe than that of wound by 12 643 J. Conclusion　The injury degree is closely related to the mass and the momentum of the super high velocity fragment, the more the momentum is,the greater the execution is. No significant relationship exist between the injury degree and the energy.

Observation on the craniocerebral injury of sheep by high explosive shell / 第三军医大学学报

Objective　To observe the characteristics and rules of craniocerebral injury resulting from a high explosive shell to provide the bases for treating explosive injury. Methods　A total of 36 sheep were distributed at the distance 6 to 48 m away from the explosive center and the shell was exploded electrically at 7 m above the earth. At the same time, the velocity of fragments and shock wave pressure were determined. Gross and pathological observations were performed after injury. Results　Among all sheep with fragment injury, craniocerebral injury was 32%. Their immediate death rate was 75% and all died 6 h later. The incidence rates of penetrating wound and blind wound were 75% and 25% respectively. Pollution of wound track was heavy. The percentage of head lost was 50% in sheep and 50% of injured animal suffered from comminuted fracture of skull base. Bleeding was found extensively on the surface of the cerebrum, even medulla oblongata was involved. Hemorrhage, edema, rupture of small blood vessels and degeneration of neuron were found at the regions 4 cm away from the wound tract with light microscopy. Combined blast injury was found and occurred most often in the abdomen and limbs, both accounting for 62.5%, and combined thoracic injury was the third, up to 50%. All the animals of craniocerebral injury combined with lung blast injury. Conclusion　High explosive shells destroy cranium badly and extensively. Many skulls are lost and the cranial base is readily fractured. The wound track is heavily polluted. Combined injury is more often occurred.