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Craniocerebral war injury, mainly caused by weaponry equipment and wartime conditions during warfare, are characterized by high difficulty in treatment and evacuation as well as high mortality rate. The field surgical treatment of craniocerebral war injury is not only related to injury characteristics, but also to factors such as war scale, combat style, combat area and weapon power. In recent years, there have been few comprehensive reports on the characteristics and field surgical treatment of craniocerebral war injury in China. Therefore, the authors reviewed the research progress in the characteristics and field surgical treatment of craniocerebral war injuries in foreign armies since 2001, with the aim to provide a reference for relevant basic researches and war injury treatment in China.
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The high-altitude craniocerebral firearm trauma can induce severe injuries with poor prognosis. Compared with the plain area, the bullets show faster velocity, longer shooting range, and greater kinetic energy due to the low pressure, low oxygen, cold, and dry climate at high altitude, resulting in more serious cerebral tissue damage and higher mortality. At present, there are few studies over craniocerebral firearm trauma at high altitude. Therefore, the authors discuss craniocerebral firearm trauma at high altitude from aspects of epidemiological and pathological characteristics, diagnosis, and treatment in combination with the situation in plain area, so as to provide a reference for the basic research and clinical treatment of craniocerebral firearm trauam at high altitude.
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Posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are the signature injuries of modern war. The comorbidity rate of PTSD and mTBI in American and British soldiers is 23% and 33%-36%, respectively. At present, there is no early diagnosis methods, specific treatment methods or drugs, which seriously affects the combat effectiveness of the army. The authors summarize the clinical and basic researches in recent years from incidence, comorbidity, clinical manifestations, diagnostic and treatment methods in an attempt to offer a reference for the treatment of PTSD and mTBI in soldiers.
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As one of the most important immune cells in the body,macrophage not only eliminates the "foreign matter" and accelerates wound healing,but also polarizes itself to the M1 or M2 phenotype as a result of local microenvironment effect.The M1 phenotype macrophage exacerbates nervous system injury,while the M2 phenotype promotes regeneration of nerve system structure and function after injury.In order to better understand the role of macrophage polarization in the course of nervous system injury,this review attempts to explore macrophage from the four aspects:the source of macrophage and its polarization,role of macrophage polarization in nerve injury repair,effect of age factor in macrophage polarization in the nerve injury repair and effect of artificial regulation on macrophage polarization in nerve injury repair.
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BACKGROUND:Bone defects are the leading cause of nonunion after firearm injury. Firearm injury is relatively special. Autograft and alograft al have big drawbacks, which cannot meet the requirements of basic-level hospitals. Using tissue-engineered bone with good blood vessels and osteogenic capability in repair of firearm bone defect wil be an ideal and feasible restoration method. OBJECTIVE: To explore the application of human vascular endothelial growth factor 121 gene-modified materials in the repair of firearm-induced radial injury in rabbits. METHODS: A total of 128 rabbits were randomly divided into surgical injury group and firearm injury group (n=64 per group). In the firearm injury group, 0.25 g steel bal was launched using 56-style musket to establish a firearm radial injury model; in the surgical injury group, surgical methods were used to produce a 1.2 cm radial injury model. Human vascular endothelial growth factor 121 gene-modified materials were used. The related histocytes from rabbits were harvested to obtain bone marrow stromal cels for culture. A porous scaffold material was prepared. The obtained materials were respectively implanted into radial defect sites in the surgical injury and firearm injury groups. The application of human vascular endothelial growth factor 121 gene-modified materials in rabbit radial defect repair was analyzed. RESULTS AND CONCLUSION: Compared with the surgical injury group, at 8, 12 and 16 weeks after repair, the gray level ratio of bone defect site and the anti-compression mechanical ratio at the healthy and repairing sides of the radius in the firearm injury group were decreased (P < 0.05), and the new bone area increased (P < 0.05). At 2 and 4 weeks after repair, the local blood flow at the repair area was significantly increased (P < 0.05). These results suggest that compared with the surgical injury group, the curative effect of human vascular endothelial growth factor 121 gene is more ideal in the firearm injury group because of the emergence of local ischemia and hypoxia in the process of radial defect repair. Human vascular endothelial growth factor 121-modified material can repair bone marrow stromal cels. The application of human vascular endothelial growth factor 121 in firearm burns can enhance the synthesis and secretion of angiogenic factors, improve the local blood flow, reduce anti-compression mechanical ratio, and increase the new bone area.
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Objective To explore the expression of glial cell line-derived neurotrophic factor (GDNF) in rats with spinal cord injury (SCI) after epidermal neural crest stem cells (EPI-NCSCs) transplantation.Method EPI-NCSCs were isolated from GFP transgenic rats for transplantation.The rat SCI model was made by NYU-II impactor (10 g 25 mm) at T10 level.Then 30 SD rats were randomly divided into blank injury group (group A),DMEM transplantation group (group B),and experimental group (group C).The EPI-NCSCs were transplanted into the injured region one week after SCI.In DMEM group,the DMEM/F12 was used to substitute for the EPI-NCSCs.No treatment was done in blank injury group.The locomotor function was appraised by BBB score every week after transplantation.At sixth week after transplantation,GDNF mRNA and protein expression was detected.Result The BBB score in experimental group was significantly higher than the other two groups from two weeks after transplantation (P＜0.05).The expression of GDNF mRNA and protein in experimental group was significantly higher than the other two groups (P＜0.05).There was no significant difference between blank injury group and DMEM transplantation group (P ＞ 0.05).Conclusion The expression of GDNF can be up-regulated by EPI-NCSCs transplantation,which may be one of the mechanisms for EPI-NCSCs repairing SCI.
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Objective To detect the myelinating role of olfactory ensheathing cells (OECs in the contused spinal cord and their impact on remyelination.Methods The rats were subjected to spinal cord injury at T10(10 g ×25 mm) using a NYU-Ⅱ impactor.One week later,the rats were transplanted with green fluorescence protein (GFP)-OECs (OECs group) or an equal volume of Dulbecco' s modification of Eagle's medium (DMEM) (control group) at epicenter of the injury as well as its rostral and caudal sites.Six weeks after transplantation,the spinal cords were removed for frozen section.Myelin basic protein (MBP),protein zero (P0),and S100 protein (S100) were determined with qualitative and semi-quantitative immunocytochemical assay.Moreover,plastic embedded semithin and ultrathin sections were prepared for qualitative and semi-quantitative examination under light microscopy and electroscopic study of myelin sheath ultrastructure.Results In OECs group,the nerve fibers labeled with S100,MBP,and PO were extended from the normal tissues to the injured region and even grew through the region with space consuming of 12.3％,11.6％,and 9.3％ respectively.Moreover,there were no statistical differences regarding the number of fibers labeled by the three proteins,but all were significantly larger than that in control group (2.89％,P ＜ 0.01).Number of myelinated nerve fibers in injured regions on hemithin sections was increased significantly to 354.67 ± 59.00 in OECs group,with significant difference compared with 167.33 ± 42.16 in control group (P ＜ 0.01).The regenerated myelin sheaths in OECs group were smaller and thicker than those in control group.Conclusions OECs can accelerate regeneration of myelinated nerve fibers.Additionally,some OECs form myelin sheaths themselves,but the sheath structures are relatively thinner.
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Neural crest stem cells originated from hair follicle (epidermal neural crest stem cell, EPI-NCSC) are easy to obtain and have potentials to differentiate into various tissues, which make them eminent seed cells for tissue engineering. EPI-NCSC is now used to repair nerve injury, especially, the spinal cord injury. To investigate their effects on repairing peripheral nerve injury, EPI-NCSC from a GFP-SD rat were primarily cultured on coated dishes and on a poly lactic acid coglycolic acid copolymer (PLGA) membrane. Methyl thiazolyl tetrazolium (MTT) assay showed that the initial adhesion rate of EPI-NCSC was 89.7% on PLGA membrane, and the relative growth rates were 89.3%, 87.6%, 85.6%, and 96.6% on the 1st, 3rd, 5th, 7th day respectively. Cell cycles and DNA ploidy analysis demonstrated that cell cycles and proliferation indexes of cultured EPI-NCSC had the same variation pattern on coated dishes and PLGA membrane. Then cultured EPI-NCSC were mixed with equal amount of extracellular matrix and injected into a PLGA conduit to connect a 10 mm surgery excision gap of rat sciatic nerve, Dulbecco's Modified Eagle's medium (DMEM) was used to substitute EPI-NCSC in the control group. After four weeks of transplantation, the defected sciatic nerve achieved a histological restoration, the sensory function of rat hind limb was partly recovered and the sciatic nerve index was also improved. The above results showed that a PLGA conduit filled with EPI-NCSC has a good repair effect on the peripheral nerve injury.
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Animals , Rats , Cells, Cultured , Neural Crest , Cell Biology , Neural Stem Cells , Cell Biology , Rats, Sprague-Dawley , Sciatic Nerve , Pathology , Spinal Cord Injuries , Stem Cell Transplantation , Tissue EngineeringABSTRACT
Objective To observe the expression of brain-derived neurotrophical factor (BDNF) in injury spinal cord after transplantation olfactory ensheathing cells (OECs), and to investigate the mechanism of OECs repairing spinal cord injury.Methods OECs from GFP transgenic rats were separated and cultured for transplantation. Spinal cord injury rats were separated two groups by random digits table. In experimental group, OECs suspension were transplanted into injured spinal cord following spinal cord injury. In control group, DMEM was transplanted into the injured spinal cord after spinal cord injury. Motor function was evaluated per week after transplantation. The expression levels of BDNF mRNA and protein were detected by using RT-PCR and immunohistochemistry respectively, and compared with those from normal SD rats.Results Motor function of two groups was improved gradually after transplantation. The motor function scores in experimental group was obviously higher than in control group at 21st day after transplantation (P<0.05). A lot of survival GFP OECs distributed around impaired myeloid tissue. At 21st day after transplantation, BDNF mRNA and protein expression in experimental group were strongest (P<0.05), and stronger in control group than in normal group (P<0.05).Conclusion The transplantation of OECs can repair the injured spinal cord by increasing the expression of BDNF mRNA and protein to improve local microenvironment.
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Objective To evaluate the regional cerebral metabolic changes in different episodes by magnetic resonance spectroscopy (MRS) after explosive brain injury in rabbits. Methods Fortyfive New Zealand white rabbits were randomly divided into eight groups, ie, normal control group( 10 rabbits) and trauma group (35 rabbits). The explosive injury in trauma group was induced by explosion of 600 mg TNT equivalent of paper detonators at 6.5 cm above the rabbit brain. The rabbits in trauma group was divided into 1,6, 12, 24 hours, 3, 7, 14 days subgroups (6 rabbits per group). The survival rate was observed at different time points after explosive injury. The MRS was used to detect the regional cerebral metabolic changes including N-acetylaspartate (NAA)/creatine (Cr) ratio and choline(Cho)/Cr ratio as well as evolution of blast injuries over time. Results The rabbits survived for overseven days in the trauma groups, with typical brain contusion manifested by pathological and conventional MRI. Compared with the normal control group, the NAA/Cr ratio was markedly decreased at one hour after injury, slightly rose again at 24 hours and fell again after seven days. The Cho/Cr ratio was markedly increased at one hour after injury, slightly fell again at 12 hours and rose again at three days after injury.Conclusions MRS can manifest the regional cerebral metabolic changes of rabbits with explosive injury at different time points and hence provide a theoretical basis for understanding the local tissue changes and determining the type of tissue damage after blast injury.
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Objective To observe the migration and distribution of OECs in injured spinal cord and discuss their relation with the recovery of spinal cord function. Methods The rats were contused by a force of 10 g · 25 mm with NYU-impactor at T10 level. The OECs acutely isolated from green fluorescence protein (GFP) rats were purified, identified and then transplanted into the injured site and the rostral and caudal parts of the spinal cord one week after injury, with total volume of the transplanted OECs for 90 000/μl. Within 13 weeks after transplantation, the migration and distribution of OECs were qualitatively observed on the cryo-sections under fluorescence light microscope. The area and the length of OECs distribution were semi-quantitatively determined. The locomotor function of the spinal cord was appraised by BBB score. Results OECs were located collectively in the transplanted site at early stage after transplantation and then spread gradually mainly along the long axis of the cord. OECs could be found in the cavity of the contused spinal cord. The area and the length of OECs distribution were increased from 1.33 mm2 and 4.23 mm respectively at one week to 3.30 mm2 and 7.68 mm respectively at 13 weeks after transplantation. In the meantime, the locomotor function was gradually improved. Conclusion OECs can migrate within the contused spinal cord, as may contribute to the recovery of locomotor function.
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Objective To explore the protective effect of olfactory ensheathing cell(OEC)Schwann cell(SC)-extracellular matrix(ECM)-poly(DL-lactide-co-glycolide acid)(PLGA)bridging complex on peripheral target organ and spinal cord neurons after rat sciatic nerve defect.Methods A 15 mm right sciatic nerve defect model was established in SD rats and repaired with OEC-SC-ECM-PLGA bridging complex that contained OEC,SC,ECM and self-made PLGA conduit.At the same time,the study set OEC-ECM-PLGA group,SC-ECM-PLGA group,ECM-PLGA group,PLGA group and nerve autograft control group.At 1,3,6 and 9 weeks after surgery,the gastrocnemius muscle water weight test and motor end-plate test were performed.At the 9th week after surgery,CM-DiI and horseradish peroxidase(HRP)retrograde tracing were performed.Results The gastrocnemius muscle water weight and number of motor end-plate were decreased in all groups after surgery but gradually increased after three weeks except for ECM-PLGA group and PLGA group.At the 9th week,OEC-SC-ECM-PLGA group showed no statistical differences with nerve autograft group in aspects of gastrocnemius muscle water weight,number of motor end-plate and length of motor end-plate major axis(P ＞ 0.05).At the 9th week,CM-DiI and HRP retrograde tracing found that the number of positive neurons in spinal cord in OEC-SC-ECM-PLGA group showed no statistical differences compared with nerve autograft group(P ＞0.05).Conclusions OEC-SC-ECM-PLGA bridging complex can partially protect peripheral target organ and spinal cord neurons after rat sciatic nerve defect.
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Objective To investigate the changes of nitric oxide content and inducible nitric oxide synthase (iNOS) activity in rat brain tissues after explosive craniocerebral wound and observe the influence of emodin on these changes. Methods After rats were subjected to electric detonators, emodin (10 mg/kg) was injected intraperitoneally at 10 minutes. Water content of brain tissues was measured by using dry-wet methods. The content of nitric oxide and the activity of iNOS were measured at 2, 4, 12 and 24 hours respectively after wound by means of nitrade reductase and colorimctrie method. Results The content of nitric oxide and the activity of iNOS kept at a high level (P<0.01). The content of nitric oxide and the activity of iNOS in model group were increased significantly and reached peak at 2 hours after wound. While the content of nitric oxide and the activity of iNOS in emodin group were significantly lower than that in model group (P<0.01). Conclusion Emodin plays a role in decreasing water content of brain tissues and inhibiting activity of iNOS and may exert a protective effect on brain injury during pathological course after explosive craniocerebral wound.
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Objective To observe effects of BMP-4 gene combined with TGF-β1 in repairing rabbit femur defect resulted from firearm wound. Methods The femur defect was made with firearm steel ball. Plasmid encoded BMP-4 gene identified in vitro and TGF-β1 were injected into the tissue of upper, lower and central parts of the defects at the second week after wound. The mRNA and protein expressions of BMP-4 in vivo were detected by real time-polymerase chain reaction (RT-PCR) and Western blot. Activity of alkaline phosphatase (ALP) and calcium content were measured for evaluating osteogenetic ability. The process and quality of osteogenesis were determined by pathological and X-ray examinations. Results mRNA and protein of BMP-4 could continually express for six weeks in vivo after injection. Activity of ALP in the experimental group was increased to ( 13.17 ±0.51 ) U/100 ml at the 8th week, which was significantly higher than (8.77 ± 0.44) U/100 ml in the control group, indicating that osteogenetic ability was markedly enhanced, which accorded with determination of calcium content. Pathological observation and X-ray proved prominent improvement of osteogenesis, with a shorter time and better quality, in the experimental group. Conclusion BMP-4/TGF-β1 can promote repair of firearm femur defect.
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There is close relationship between the morphologic changes of peripheral nerve after injury and its function recovery during regeneration. In our experiment, the sciatic nerve of rats was transected and bridge-connected with silicone tube, and the images of serial slices of different time and different injury parts were taken by micro-photograph system. The volume unit model was applied to rendering the three dimensional (3D) structure of degenerative and regenerative sciatic nerve fiber and its affiliated structure after injury. The 3D images showed that node of Ranvier had not formed and its array was turbulent, both the myelin sheath and the axis-cylinder were thinner, and the collagen fibres had proliferated.
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Animals , Male , Rats , Nerve Regeneration , Physiology , Rats, Wistar , Recovery of Function , Sciatic Nerve , Wounds and Injuries , PathologyABSTRACT
Objective To observe the characteristic, mechanisms and the change of pathophysiology about thoracic explosive injury from an explosive device. Methods Seventy-three millimetres prefabricated steel-ball bomb was used to be the center of explosion. According to the distance from each group to the center of explosion, 30 sheep were randomly divided into 5 groups. The injuries of thoracic wall, lung and surrounding organs were observed from fragments and blast wave. Results The mortality of thoracic explosive injury on the ground testing was 56.7%.Most of fragment wounds were blind wound. The track of wounds was often complicated and curved. The major associated injuries were myocardial contusion, splenic-hepatic rupture and gastric-enteric rupture. There were much severe pulmonary hemorrhage and lung edema. The parameters of trauma were well correlated with the severity of thoracic injury. Conclusion The parameters of trauma were well correlated with the severity of thoracic injury. The characteristic of thoracic injury from explosive device was more complicated and severe.
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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.
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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.
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Using microsurgery techniques, we transplanted a piece of embryonic spinal cord (E_(14)) into spinal cord of adult rats that were hemisectly injured, with a small cavity left in it. The results were observed at days 7, 15. 30, 60, 120 and 240 after operation. The findings showed that 74% of the transplants could survive under pathological environment of the host spinal cord. They not only grew and differentiated continuously but also connected tightly with the host tissue. It is suggested that the defect tissue of injured adult spinal cord may at least be repaired with homotypic tissue by transplanting embryonic spinal cord cautiously with suitable age.
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The number of nerve fibers in the spared dorsal root of the L4 spinal nerve and the number of nerve terminals in the Lamina Ⅲ of the segment of the spinal cord between L2 and S1 were determined with electron microscopic morphometry,and the distribution and density of nerve fibers in the spinal cord were observed with silver staining.It was found that the distribution and density of nerve fibers in the spinal cord showed no difference between the operated and the control sides under optical microscopy;morphometric analysis revealed a significant increase of the number of unmyelinated fibers and a tendency to increase of their diameter;and the number of both simple and complex terminals in the Lamina Ⅲ of the spinal cord could return to the normal level on the 35th day after operation with a significant increase of their diameter.The importance of these changes was preliminarily discussed.