Minimally Invasive Microsurgery for Cerebral Contusions / Microcirurgia minimamente invasiva para tratamento de contusões cerebrais

Introduction Traumatic brain injury (TBI) is among the main causes of death and neurological sequelae worldwide. Injuries are classified as diffuse (diffuse axonal injury and brain swelling) or focal (cerebral contusion [CCo], epidural hematoma, and acute subdural hematoma). Among all TBIs, CCos are the most frequent focal lesion, and treatment modalities are many. Hematoma evacuation using large craniotomies has been well described in the literature. The main goal of the present study is to discuss the advantages of minimally invasive approaches for the treatment of CCos, regarding operative time, blood loss, and postoperative tomographic results. Methods An integrative literature review was conducted on the SciELO, LILACS, and PubMed databases. Seven case reports were included in the present study. Retrospective data collection was performed, analyzing gender, age, Glasgow coma scale score on hospital admission, surgical approach, and postoperative (tomographic) results. Results The minimally invasive keyhole approach was used in seven patients with CCos. The supraorbital approach (n » 5) was performed for frontal lobe contusions, and the minipterional approach (n » 2) was performed for temporal lobe contusions. All cases had adequate hematoma evacuation, confirmed by postoperative computed tomography scans. Conclusion The minimally invasive approaches were effective for hematoma evacuation, with adequate clinical and radiological postoperative results.

Introdução O traumatismo cranioencefálico se encontra entre as principais causas de óbito e sequelas neurológicas na estatística mundial. As lesões são classificadas como difusas (lesão axonal difusa e edema cerebral traumático) ou focais (contusões cerebrais [CoC], hematoma epidural, e hematoma subdural agudo). Dentre todos os tipos de lesões cerebrais traumáticas, as contusões são a lesão focal mais comum, e são reservadas a elas múltiplas modalidades de tratamento. O principal objetivo desse estudo é discutir as vantagens dos acessos minimamente invasivos no tratamento de contusões cerebrais, especialmente no que concerne à duração do procedimento, perda sanguínea e resultados tomográficos pós-operatórios. Métodos Uma revisão integrativa de literatura foi conduzida nas plataformas Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e PubMed. Sete relatos de caso foram incluídos neste estudo. A coleta retrospectiva de dados foi realizada com a análise das seguintes variáveis: gênero, idade, escala de coma de Glasgow à admissão, acesso cirúrgico utilizado e resultados tomográficos pós-operatórios. Resultados O acesso cirúrgico minimamente invasivo foi utilizado em sete pacientes com CoC. O acesso supraorbital (n » 5) foi usado para tratar contusões frontais, enquanto o acesso minipterional (n » 2) foi usado para o tratamento de contusões temporais. Em todos os casos, foi obtida drenagem satisfatória do hematoma, confirmada por meio de tomografias pós-operatórias. Conclusão Os acessos minimamente invasivos foram efetivos para evacuação dos hematomas intraparenquimatosos, com resultados clínicos e tomográficos favoráveis.

Application value of ventricular intracranial pressure monitoring in the treatment of unilateral temporal lobe cerebral contusion / 中华创伤杂志

Objective:To explore the application value of ventricular intracranial pressure monitoring (V-ICPM) in the treatment of unilateral temporal lobe cerebral contusion.Methods:A retrospective cohort study was conducted to analyze the clinical data of 295 patients with unilateral temporal lobe cerebral contusion admitted to 904th Hospital of PLA Joint Support Force from January 2014 to August 2021, including 172 males and 123 females; aged 14-78 years [(46.3±14.7)years]. V-ICPM was used in 136 patients (V-ICPM group), who received surgical or non-surgical treatment according to the monitoring, while not in 159 patients (non-V-ICPM group), who received routine surgery or non-surgical treatment. The two groups were compared in terms of the rates of intracranial hematoma clearance by craniotomy, decompressive craniectomy (DC) and dehydration and osmotic therapy during hospitalization, use time of 20% mass fraction of mannitol and 30 g/L hypertonic salt, displacement rate of brain midline structure of head CT≥10 mm after discharge, rate of intracranial infection, hydrocephalus and epilepsy, and Glasgow Outcome Scale (GOS) at 6 months after discharge.Results:All patients were followed up for 6-12 months [(8.9±2.1)months]. During hospitalization, the rate of intracranial hematoma clearance by craniotomy and the rate of DC in V-ICPM group were 35.3% (48/136) and 8.1% (11/136), lower than 47.2% (75/159) and 22.0% (35/159) in non-V-ICPM group ( P<0.05 or 0.01). There was no significant difference between the two groups in the rate of dehydration and osmotic therapy or the use time of mannitol (all P>0.05). The use time of hypertonic salt in V-ICPM group was (7.2±2.5)days, more than (4.1±1.8)days in non-V-ICPM group ( P<0.05). After discharge, the displacement rate of brain midline structure of head CT in V-ICPM group was 29.4% (40/136), lower than 42.8% (68/159) in non-V-ICPM group ( P<0.05). There was no significant difference between the two groups in the rate of intracranial infection, hydrocephalus and epilepsy (all P>0.05). Six months after discharge, the good rate of GOS in V-ICPM group was 91.2% (124/136), significantly better than 81.8% (130/159) in non-V-ICPM group ( P<0.05). Conclusion:For unilateral temporal lobe cerebral contusion, V-ICPM is associated with reduced rate of craniotomy exploration and DC, decreased incidence of complications and improved prognosis of the patients in spite of longer use time of hypertonic salt.

Effects of contusion and exhaustive exercise on murf1 and mafbx in the skeletal muscle of rats / Efectos de la contusión y del ejercicio exhaustivo sobre murf1 y mafbx en el músculo esquelético de ratas / Efeitos do trauma contuso e do exercício exaustivo no em murf1 e mafbx no músculo esquelético de ratos

ABSTRACT Objective To study the effects of contusion and exhaustive exercise on the expression of degradation-related factors MuRF1 and MAFbx in the skeletal muscle of rats and describe the repair mechanism of skeletal muscle injury. Methods Forty-two male SD rats were randomly divided into 7 groups. The rats in each group were killed at different time points (0h, 24h, 48h) after exhaustive exercise (E0, E24, E48) and contusion (D0, D24, D48), respectively, and in the resting state in control group (C). The right gastrocnemius muscles were resected and divided into two parts, one for the mRNAs of MuRF1 and MAFbx by real-time PCR, and the other for protein measurement by Western blotting. Results Compared with the control group, the MuRF1 mRNA and protein expression of the skeletal muscle in the E0 group was markedly increased (P <0.05) and followed by a downward trend in E24 the E48 groups. On the other hand, MuRF1 mRNA expression of the skeletal muscle in the D24 group was significantly upregulated (P <0.01), then decreased in the D48 group (P <0.01). Meanwhile, compared with the C group, MAFbx mRNA gene expression continued to be upregulated in D24 and D48 (P <0.05), but decreased in E24 and E48 (p<0.01). On the other hand, the NF-κB protein contents of the skeletal muscle in the D0, D24, and D48 groups, as well as in the E48 group, were markedly downregulated (P <0.05), and the one in E48 was also remarkably downregulated (P <0.05). Conclusion NF-κB may negatively regulate the process of protein degradation by the NF-κB / MuRF1 signal pathway. Level of evidence III; Therapeutic studies investigating the results of treatment.

RESUMEN Objetivo Estudiar los efectos de la contusión y del ejercicio exhaustivo sobre la expresión de los factores relacionados con la degradación MuRF1 y MAFbx en el músculo esquelético de ratas y describir el mecanismo de reparación de la lesión muscular esquelética. Métodos Cuarenta y dos ratas macho SD fueron divididas aleatoriamente en 7 grupos. Las ratas de cada grupo fueron sacrificadas en diferentes momentos (0h, 24h, 48h) después del ejercicio exhaustivo (E0, E24, E48) y de la contusión (D0, D24, D48), respectivamente, y en estado de reposo en el grupo de control (C). Se resecaron los músculos gastrocnemios derechos y se dividieron en dos partes, una para los ARNm de MuRF1 y MAFbx mediante PCR en tiempo real y la otra para la medición de proteínas mediante Western blot. Resultados En comparación con el grupo control, el ARNm de MuRF1 y la expresión proteica del músculo esquelético en el grupo E0 se incrementó notablemente (P <0,05) y fueron seguidos por una tendencia a la baja en los grupos E24 y E48. Por otra parte, la expresión del ARNm de MuRF1 del músculo esquelético en el grupo D24 fue significativamente regulada al alza (P <0,01), y luego disminuyó en el grupo D48 (P <0,01). Mientras tanto, en comparación con el grupo C, la expresión génica del ARNm de MAFbx permaneció regulada al alza en D24 y D48 (P <0,05), pero disminuyó en E24 y E48 (p<0,01). Por otro lado, el contenido de proteína NF-κB del músculo esquelético en los grupos D0, D24 y D48, así como en el grupo E48, se vio notablemente regulado a la baja (P <0,05), y el del grupo E48 también se vio notablemente regulado a la baja (P <0,05). Conclusión NF-κB puede regular negativamente el proceso de degradación de la proteína a través de la vía NF-κB / MuRF1. Nivel de evidencia III; Estudios terapéuticos que investigan los resultados del tratamiento.

RESUMO Objetivo Estudar os efeitos do trauma contuso e do exercício exaustivo na expressão dos fatores relacionados à degradação MuRF1 e MAFbx no músculo esquelético de ratos e descrever o mecanismo de reparo da lesão muscular esquelética. Métodos Quarenta e dois ratos SD machos foram divididos aleatoriamente em 7 grupos. Os ratos de cada grupo foram mortos em diferentes momentos (0h, 24h, 48h) após exercício exaustivo (E0, E24, E48) e trauma contuso (D0, D24, D48), respectivamente, e no estado de repouso no grupo controle (C). Os músculos gastrocnêmios direitos foram ressecados e divididos em duas partes, uma para os mRNAs de MuRF1 e MAFbx por PCR em tempo real e outra para a medição de proteínas a partir do Western blot. Resultados Em comparação com o grupo controle, o mRNA de MuRF1 e a expressão proteica do músculo esquelético no grupo E0 foram acentuadamente aumentados (P <0,05) e seguidos por uma tendência descendente nos grupos E24 e E48. Por outro lado, a expressão do mRNA de MuRF1 do músculo esquelético no grupo D24 foi significativamente regulada para cima (P <0,01), depois diminuiu no grupo D48 (P <0,01). Enquanto isso, em comparação com o grupo C, a expressão gênica do mRNA de MAFbx continuou regulada para cima em D24 e D48 (P <0,05), mas diminuiu em E24 e E48 (p<0,01). Por outro lado, os teores de proteína NF-κB do músculo esquelético nos grupos D0, D24 e D48, bem como no grupo E48, foram marcadamente regulados para baixo (P <0,05), e o do grupo E48 também foi notavelmente regulado para baixo (P <0,05). Conclusão NF-κB pode regular negativamente o processo de degradação da proteína pela via NF-κB / MuRF1. Nível de evidência III; Estudos terapêuticos que investigam os resultados do tratamento.

MULTIDETECTOR COMPUTED TOMOGRAPHY IN BLUNT CHEST TRAUMA SINGLE TERTIARY CARE TRAUMA CENTRE EXPERIENCE.

Thoracic injuries are significant causes of morbidity and mortality in trauma patients, second only to head injuries. In addition to conventional radiography, multidetector computed tomography (CT) is increasingly being used, since it can quickly and accurately help diagnose a wide variety of injuries in trauma patients. Furthermore, multiplanar and MiNIP, volumetric reformatted CT images provide improved visualization of injuries, increased understanding of trauma-related diseases, and enhanced communication between the radiologist and the referring clinician. To identify and accurately a Aims: ssess variety of injuries in blunt thoracic trauma with multidetector Computed Tomography (MDCT). To find commonest pattern of intrathoracic injury related to blunt chest trauma. This Method: retrospective observational study included 50 patients who underwent Multidetector CT examination during the period from November 2020 to April 2021 at tertiary care trauma centre, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai. Blunt chest Conclusion: trauma injuries were classified into pleural injury, lung parenchymal injury, bony thorax, tracheobronchial and vascular injuries. The commonest injury detected was pleural (70%) followed by lung parenchymal injury (52%) and bony thorax injury in 50% cases. 50% of the pleural injury cases were associated with rib fractures. Multiple injuries were seen in the 47 patients, stating the importance of a detail evaluation of all chest components. No oesophageal and cardiac injury was detected in our CT studies' with its multiplanar, MinIP and volume reconstruction images increases the confidence in imaging diagnosis and play a critical role in understanding thoracic trauma related complications.

Clinical analysis of 37 patients with bilateral frontal lobe contusion / 中国基层医药

Objective:To investigate the treatment methods and their efficacy for bilateral frontal lobe contusion.Methods:The clinical data of 37 patients with bilateral frontal lobe contusion who received treatment in Fujian Provincial Hospital between May 2017 and May 2018 were analyzed. The 37 patients were divided into surgical group ( n = 19) and non-surgical group ( n = 18) according to different treatment methods. Clinical efficacy was compared between the two groups. All patients underwent intracranial pressure monitoring. Intracerebral pressure was divided into three stages: < 20 mmHg, 20-40 mmHg, > 40 mmHg. Clinical efficacy was compared among patients with different levels of intracranial pressure. Results:In the surgical group, one patient died, one patient was in a vegetative state, two patients had severe disability, eight patients had mild disability, and seven patients well recovered. In the non-surgical group, four patients died, three patients were in a vegetative state, six patients had severe disability, three patients had mild disability, and two patients well recovered. There was significant difference in good recovery rate between the two groups ( χ2 = 9.83, P < 0.05). The good recovery rate was statistically significant among patients with different levels of intracranial pressure ( χ2 = 7.97, P < 0.05). The vegetative state rate in patients with > 40 mmHg intracranial pressure was significantly higher than that in patients with < 20 mmHg intracranial pressure (50.0% vs. 0.0%, χ2 = 7.65, P < 0.05). The good recovery rate in patients with > 40 mmHg intracranial pressure was significantly lower than that in patients with < 20 mmHg intracranial pressure (0.0% vs. 61.5%, χ2 = 7.57, P < 0.05). Conclusion:The choice of treatment for bilateral frontal lobe contusion mainly depends on clinical symptoms, dynamic brain CT findings, and the changes in dynamic intracranial pressure monitoring. Active surgery can reduce the incidence of death and severe disability. Intracranial pressure monitoring has a positive role in guiding clinical treatment.

Comparison of chest CT scan findings between COVID-19 and pulmonary contusion in trauma patients based on RSNA criteria: Established novel criteria for trauma victims / 中华创伤杂志(英文版)

PROPOSE@#In this study, we re-assessed the criteria defined by the radiological society of North America (RSNA) to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary contusion.@*METHODS@#All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion, COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020. Included patients (Group P) were then classified into two groups based on polymerase chain reaction tests (Group Pa for positive patients and Pb for negative ones). Moreover, 44 patients from the pre-pandemic period (Group PP) were enrolled. They were matched to Group P regarding age, sex, and trauma-related scores. Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria. The radiological findings were compared between Group P and Group PP; statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter. Finally, the sensitivity and specificity of each significant findings were calculated. The Chi-square test was used to compare the radiological findings between Group P and Group PP.@*RESULTS@#In the Group PP, 73.7% of all ground-glass opacities (GGOs) and 80% of all multiple bilateral GGOs were detected (p < 0.001 and p = 0.25, respectively). Single bilateral GGOs were only seen among the Group PP. The Chi-square tests showed that the prevalence of diffused GGOs, multiple unilateral GGOs, multiple consolidations, and multiple bilateral consolidations were significantly higher in the Group P (p = 0.001, 0.01, 0.003, and 0.003, respectively). However, GGOs with irregular borders and single consolidations were more significant among the Group PP (p = 0.01 and 0.003, respectively). Of note, reticular distortions and subpleural spares were exclusively detected in the Group PP.@*CONCLUSION@#We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients. The clinical signs and symptoms are not always useful either. The presence of multiple unilateral GGOs, diffused GGOs, and multiple bilateral consolidations favor COVID-19 with 88%, 97.62%, and 77.7% diagnostic accuracy.

Prevalencia de sindrome post conmocion cerebral en pacientes atendidos en el hospital del niño. un estudio longitudinal de julio a octubre de 2019 / Prevalence of post-concussion syndrome in patients seen at the children's hospital. A longitudinal study from July to October 2019

INTRODUCCIÓN. El síndrome post conmoción cerebral (SPC) es una secuela muy común de la conmoción cerebral (CC). El diagnóstico es desafiante porque los síntomas varían de paciente a paciente, son auto informados, sutiles y los estudios de imagen convencionales pueden o no revelar anomalías mínimas. ¿Cuál es la prevalencia del síndrome post conmoción cerebral en pacientes que fueron atendidos en el Hospital del Niño Dr. Ovidio Aliaga Uría? MATERIAL Y MÉTODO. Estudio descriptivo longitudinal, que enroló 45 pacientes de 1 a 15 años de edad, durante los meses de julio a octubre de 2019. Se utilizó la herramienta SCAT5 modificado como cribado, diagnóstico y seguimiento del SPC. Se evaluó a cada paciente de forma individual en 5 entrevistas planificadas. El análisis descriptivo utilizó medidas de tendencia central y dispersión. Para el análisis inferencial se empleó pruebas de correlación. RESULTADOS. Se encontró una prevalencia del 22,2% (n=10) en el segundo mes de seguimiento que reduce a 6,6% (n=3) hasta el tercer mes. DISCUSIÓN. Las definiciones más aceptadas de SPC son de la Clasificación Internacional de Enfermedades 10a revisión (CIE-10) y del Manual Diagnóstico y Estadístico de los Trastornos Mentales, quinta edición (DSM-5). Las náuseas y la somnolencia son muy comunes después de la conmoción y se resuelven rápidamente (horas o días). La cefalea abarca todo el espectro y ocurre inmediatamente después de la lesión y frecuentemente se vuelve crónica. CONCLUSIÓN. Los pacientes padecieron SPC, no existe un protocolo institucional de diagnóstico y manejo para la recuperación escalonada.

INTRODUCTION. Post-concussion syndrome (PPS) is a very common sequela of concussion (CC). Diagnosis is challenging because symptoms vary from patient to patient, are self-reported, subtle, and conventional imaging studies may or may not reveal minimal abnormalities. What is the prevalence of post-concussion syndrome in patients who were treated at the Hospital del Niño Dr. Ovidio Aliaga Uría? MATERIAL AND METHOD. Longitudinal descriptive study, which enrolled 45 patients from 1 to 15 years of age, during the months of July to October 2019. The modified SCAT5 tool was used for screening, diagnosis and follow-up of the PPS. Each patient was evaluated individually in 5 planned interviews. The descriptive analysis used measures of central tendency and dispersion. Correlation tests were used for inferential analysis. RESULTS. A prevalence of 22.2% (n = 10) was found in the second month of follow-up, which reduces to 6.6% (n = 3) until the third month. DISCUSSION. The most widely accepted definitions of SPC are from the International Classification of Diseases 10th revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Nausea and drowsiness are very common after shock and resolve quickly (hours to days). Headache spans the entire spectrum and occurs immediately after injury and frequently becomes chronic. CONCLUSION. The patients suffered from SPC, there is no institutional diagnostic and management protocol for staggered recovery.

Effects of exhaustive exercise and contusion on autophagy-related factors in skeletal muscle of rats / Efectos del ejercicio exhaustivo y de contusión sobre factores relacionados a la autofagia en el músculo esquelético de ratones / Efeitos de exercício exaustivo e de contusões sobre fatores relacionados com autofagia no músculo esquelético de ratos

ABSTRACT Objective: To study the effects of exhaustive exercise and contusion on autophagy-related factors Beclin1, LC3 and PINK1 expression in the skeletal muscle of rats. Methods: Forty-two male SD rats were randomly divided into 7 groups, 6 rats in each group: C, D0, D24, D48, E0, E24, and E48. Each group of rats was killed and dissected at the different respective time points specified above. The whole quadriceps femoris of the left hind limbs were removed and divided into two parts, one for mRNAs of Beclin1, LC3 and PINK1 by real-time fluorescent quantitative PCR, and the other for LC3 protein by Western blotting. Results: Compared with group C, the contents of Beclin1 mRNA, PINK1 mRNA, and LC3 mRNA in the immediate exhaustive exercise group (E0) were significantly reduced p<0.01. However, the levels of PINK1 mRNA, LC3 mRNA, and LC3 protein in skeletal muscle cells increased significantly in the 48 hours after exhaustion (E48) p<0.05, suggesting that cell autophagy had an increasing trend during the recovery period. Meanwhile, compared with the C group, the contents of Beclin1 mRNA, PINK1 mRNA, and LC3 mRNA in the immediate blunt contusion group (D0) increased significantly p<0.01 and were followed by a downward trend. Conclusion: Generally, there were differences between the blunt contusion and exhausted exercise models at each recovery phase. The gene expression of the autophagy-related factors was not high in the early exhaustive exercise recovery phase and subsequently followed an upward trend. But the above factors increased significantly in the immediate and early recovery phases after blunt contusion. Injury from blunt contusion may be more severe than exhaustive exercise-induced-injury, so the autophagy starts earlier according to the changes in autophagy-related factors. Level of evidence III; Therapeutic studies investigating the results of treatment.

RESUMEN Objetivo: Estudiar los efectos del ejercicio exhaustivo y de la contusión sobre la expresión de los factores relacionados a la autofagia de las proteínas Beclina 1, LC3 y PINK-1 en el músculo esquelético de ratones. Métodos: Cuarenta y dos ratones SD machos fueron divididos aleatoriamente en 7 grupos con 6 ratones cada uno: C, D0, D24, D48, E0, E24 y E48. Los ratones de cada uno de los grupos fueron sometidos a eutanasia y disecados en los diferentes puntos de tiempo de acuerdo con los grupos encima. Cada músculo cuádriceps femoral de los miembros posteriores izquierdos fue removido y dividido en dos partes, una para RNAm de Beclina 1, LC3 y PINK-1 por PCR cuantitativa fluorescente en tiempo real y la otra para la proteína LC3 por Western blotting. Resultados: En comparación con el grupo C, el tenor de RNAm en Beclina 1, PINK-1 y LC3 en el grupo ejercicio exhaustivo inmediato (E0) fue significativamente reducido (p < 0,01). Con todo, los niveles de RNAm en PINK-1 y LC3 y la proteína LC3 en células del músculo esquelético aumentaron significativamente en las 48 horas post-depleción (E48) (p < 0,05), sugiriendo que la autofagia celular tendió a aumentar durante el período de recuperación. En comparación con el grupo C, el tenor de RNAm de Beclina 1, RNAm de Pink-1 y RNAm de LC3 en el grupo contusión inmediata (D0) aumentó significativamente (p < 0,01) lo que fue seguido por tendencia de caída. Conclusión: En general, fueron encontradas diferencias entre los modelos de contusión y de ejercicio exhaustivo en cada fase de recuperación. La expresión génica de los factores relacionados con la autofagia no fue alta en la fase de recuperación del ejercicio exhaustivo inicial y, subsecuentemente, siguió tendencia ascendente. Sin embrago, los factores encima aumentaron significativamente en las fases de recuperación inmediata e inicial después de contusión. El trauma contuso puede ser más grave que la lesión inducida por ejercicio exhaustivo, de modo que la autofagia tiene inicio más temprano, de acuerdo con los cambios en los factores relacionados a la autofagia. Nivel de Evidencia III; Estudios terapéuticos - Investigación de los resultados del tratamiento.

RESUMO Objetivo: Estudar os efeitos do exercício exaustivo e da contusão sobre a expressão dos fatores relacionados com a autofagia das proteínas Beclina 1, LC3 e PINK-1 no músculo esquelético de ratos. Métodos: Quarenta de dois ratos SD machos foram divididos randomicamente em 7 grupos com 6 ratos cada um: C, D0, D24, D48, E0, E24 e E48. Os ratos de cada um dos grupos foram submetidos à eutanásia e dissecados nos diferentes pontos de tempo de acordo com os grupos acima. Cada músculo quadríceps femoral dos membros posteriores esquerdos foi removido e dividido em duas partes, uma para RNAm de Beclina 1, LC3 e PINK-1 por PCR quantitativa fluorescente em tempo real e a outra para a proteína LC3 por Western blotting. Resultados: Em comparação com o grupo C, o teor de RNAm em Beclina 1, PINK-1 e LC3 no grupo exercício exaustivo imediato (E0) foi significativamente reduzido (p < 0,01). Contudo, os níveis de RNAm em PINK-1 e LC3 e a proteína LC3 em células do músculo esquelético aumentaram significativamente nas 48 horas pós-depleção (E48) (p < 0,05), sugerindo que a autofagia celular tendeu a aumentar durante o período de recuperação. Em comparação com o grupo C, o teor de RNAm de Beclina 1, RNAm de Pink-1 e RNAm de LC3 no grupo contusão imediata (D0) aumentou significativamente (p < 0,01) o que foi seguido por tendência de queda. Conclusão: Em geral, foram encontradas diferenças entre os modelos de contusão e de exercício exaustivo em cada fase de recuperação. A expressão gênica dos fatores relacionados com a autofagia não foi alta na fase de recuperação do exercício exaustivo inicial e, subsequentemente, seguiu tendência ascendente. Porém, os fatores acima aumentaram significativamente nas fases de recuperação imediata e inicial depois de contusão. O trauma contuso pode ser mais grave do que a lesão induzida por exercício exaustivo, de modo que a autofagia tem início mais cedo, de acordo com as mudanças nos fatores relacionados com a autofagia. Nível de Evidência III; Estudos terapêuticos -Investigação dos resultados do tratamento.

Hallazgos tomográficos posoperatorios en pacientes con traumatismos torácicos / Tomographic postoperative findings in patients with thoracic trauma

Introducción: El trauma torácico se encuentra entre las primeras causas de muerte, fundamentalmente en personas jóvenes. Objetivos: Caracterizar a una población operada por traumatismos torácicos según variables clinicoepidemiológicas y describir los hallazgos tomográficos posquirúrgicos. Métodos: Se llevó a cabo un estudio observacional y descriptivo de 48 pacientes atendidos en el Servicio de Radiología del Provincial Clínico-Quirúrgico Docente Saturnino Lora de Santiago de Cuba, de enero del 2016 a diciembre del 2018, a los cuales se les realizó tomografía computarizada multidetector. Resultados: Los traumas torácicos predominaron en personas jóvenes del sexo masculino, asociadas fundamentalmente a acciones violentas que provocaron traumas abiertos. La contusión pulmonar resultó ser el hallazgo tomográfico inicial más frecuente, en tanto, el neumotórax persistente y el hemotórax coagulado constituyeron los hallazgos tomográficos más influyentes en la decisión de una reintervención quirúrgica. Conclusiones: La tomografía es un medio diagnóstico que permite una descripción detallada del estado posoperatorio de los órganos afectados, con un alto valor orientativo para decidir procedimientos quirúrgicos posteriores.

Introduction: The thoracic trauma is among the first causes of death, fundamentally in young people. Objectives: To characterize a population operated due to thoracic trauma according to clinical epidemiological variables and describe the postsurgical tomographic findings. Methods: An observational and descriptive study of 48 patients assisted in the Radiology Service of Saturnino Lora Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba, from January, 2016 to December, 2018, to whom a multidetector computed tomography was carried out. Results: The thoracic traumas prevailed in young male people, fundamentally associated with violent actions that caused open traumas. The lung contusion was the most frequent initial tomographic finding, as long as, the persistent pneumothorax and the coagulated hemothorax constituted the most influential tomographic findings in the decision of a surgical reintervention. Conclusions: Tomography is a diagnostic means that allows a detailed description of the postoperative state in the affected organs, with a high orientative value to decide later surgical procedures.

Preparing a blunt contusion model of rabbit skeletal muscle under different blow strengths / 中国组织工程研究

BACKGROUND: In current studies regarding skeletal muscle blunt contusion model, rats are often taken as the experimental object. The authors believe that rabbits are the better experimental object to observe the macroscopic and imaging changes after blunt contusion. OBJECTIVE: Based on the self-made heavy-duty smashing instrument as the experimental basis, to replicate the skeletal muscle injury model according to different strike heights, which is expected to provide a reference basis for the subsequent replication of the rabbit gastrocnemius blunt contusion model. METHODS: Thirty-three New Zealand rabbits were randomly divided into four groups: normal group (n=3), 75 cm strike group (n=10), 50 cm strike group (n=10), 25 cm strike group (n=10). Except for the normal group, all strikes were performed with different strengths. The severity of skeletal muscle damage after different strikes was compared through gross observation, hematoxylin-eosin staining, Masson staining, and ultrasound imaging. RESULTS AND CONCLUSION: The 50 cm height blow can cause moderate damage to the skeletal muscle, and the natural recovery time is over 21 days, which is suitable for the establishment of skeletal muscle blunt contusion model. The 75 cm height blow is likely to cause fractures, resulting in more deaths. The 25 cm height blow can cause mild damage that can be recovered within 7 days, which is not suitable for the establishment of skeletal muscle injury model.

Expert consensus on clinical management strategy for patients with thoracic trauma during the epidemic period of COVID-19 / 解放军医学杂志

Since December 2019, a corona virus disease 2019 (COVID-19) has been continuing to spread throughout China. This epidemic is characterized by strong infectivity and concealment. China's domestic epidemic is gradually under control by strict quarantine and control measures, meanwhile the incidence of trauma has reduced. However, with the resumption of industry and traffic, the chest trauma caused mainly by traffic accidents and high falling has increased gradually, great risks and challenges are faced in clinical treatment. Therefore, combined with the current epidemic environment and the treatment characteristics of thoracic trauma, experts from the Thoracic Trauma Group, Thoracic Surgery Branch of China International Exchange and Promotion Association for Medical and Health Care and Chest Trauma Management Committee, Guangdong Association of Thoracic Disease develop an "Expert consensus on clinical management strategy for patients with thoracic trauma during the epidemic period of COVID-19 pneumonia". In order to promote the treatment of chest trauma in a scientific and orderly way, the consensus elaborated 4 parts, including classification and treatment strategy for patients with thoracic trauma required a surgical procedure, non-operative treatment of patients with thoracic trauma, management process of chest trauma, and protection and management of ward.

Risk factors for mechanical ventilation in patients with severe multiple trauma / 北京大学学报(医学版)

OBJECTIVE@#To eludicate the risk factors of mechanical ventilation and prolonged mechanical ventilation in patients with severe multiple injuries.@*METHODS@#Consecutive patients with severe multiple injures who were treated in Peking University People's Hospital Trauma Medical Center between December 2016 and December 2019 were enrolled in this restropective chart-review study. According to mechanical ventilation and ventilatory time, the patients were divided into mechanical ventilation (MV) group and non-mechanical ventilation (NMV) groups, prolonged mechanical ventilation (PMV) group and shortened mechanical ventilation (SMV) groups. Clinical data such as gender, age, base excess, mechanism of injury, Glasgow Coma Scale (GCS), abbreviated injury scale (AIS) and injury severity score (ISS) were collected. To indentify the risk factors of mechanical ventilation and prolonged mecha-nical ventilation, univariate and multivariate Logistic analyses were carried out.@*RESULTS@#In the present study, 112 patients (82 male, 30 female) with severe multiple injuries having a median age of 52 (range: 16-89 years) and a median ISS of 34 (range: 16-66) were enrolled. The primary mechanism of injury was traffic accident injury and falling injury. In the study, 62 and 50 patients were assigned to MV and NMV groups, respectively. Logistic analysis showed that GCS (OR=0.72, 95%CI: 0.53-0.92, P=0.03), base excess (OR=0.56, 95%CI: 0.37-0.88, P=0.002) and multiple rib fracture (OR=1.72, 95%CI: 1.60-2.80, P=0.012) were independent significant risk factors for mechanical ventilation after severe multiple injuries. Within the mechanical ventilation group, 38 and 24 patients were assigned to PMV and SMVgroups, respectively. Compared with the SMV group, the PMV group had a higher ISS and higher rate of severe head trauma. The length of hospital stay of PMV group was longer than that of SMV groups. Meanwhile, the incidence of tracheotomy in PMV group was high.@*CONCLUSIONS@#GCS, base excess and rib fracture might be independent risk factors for mechanical ventilation. Higher ISS and lower GCS might prolong the ventilatory time and the length of hospital stay. Meanwhile, the incidence of tracheotomy was high in PMV group because of the longer ventilatory time and poor consciousness.

Blunt trauma related chest wall and pulmonary injuries: An overview / 中华创伤杂志(英文版)

Physical traumas are tragic and multifaceted injuries that suddenly threaten life. Although it is the third most common cause of death in all age groups, one out of four trauma patients die due to thoracic injury or its complications. Blunt injuries constitute the majority of chest trauma. This indicates the importance of chest trauma among all traumas. Blunt chest trauma is usually caused by motor vehicle accident, falling from height, blunt instrument injury and physical assault. As a result of chest trauma, many injuries may occur, such as pulmonary injuries, and these require urgent intervention. Chest wall and pulmonary injuries range from rib fractures to flail chest, pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries. Following these injuries, patients may present with a simple dyspnea or even respiratory arrest. For such patient, it is important to understand the treatment logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries. This is because only 10% of thoracic trauma patients require surgical operation and the remaining 90% can be treated with simple methods such as appropriate airway, oxygen support, maneuvers, volume support and tube thoracostomy. Adequate pain control in chest trauma is sometimes the most basic and best treatment. With definite diagnosis, the morbidity and mortality can be significantly reduced by simple treatment methods.

Risk factors for progression of patients with cerebral contusion and laceration combined with hematoma formation / 中华神经医学杂志

Objective:To observe the natural course of cerebral contusion and laceration combined with hematoma formation and analyze the risk factors for its progression.Methods:Patients with cerebral contusion and laceration combined with hematoma formation admitted to our hospital from September 2017 to March 2020 were prospectively selected; and they were divided into progressive and non-progressive groups according to progression of cerebral contusion and laceration combined with hematoma formation. The clinical data of the two groups of patients were compared, and multivariate Logistic regression was used to analyze the independent influencing factors for progressive cerebral contusion and laceration combined with hematoma formation.Results:A total of 197 patients with cerebral contusion and laceration combined with hematoma formation were included in this study, of which, 61 were treated with craniotomy and 136 were treated conservatively; 85 patients had progressive cerebral contusion and laceration combined with hematoma formation and 112 patients had non-progressive cerebral contusion and laceration combined with hematoma formation. As compared with those in the non-progressive group, the baseline Glasgow Coma Scale (GCS) scores of the progressive group were lower, hematoma volume by second CT scan was larger, distance from the center of cerebral contusion and laceration or hematoma to the nearest cortex was shorter, platelet count and thrombin time increased, fibrinogen (FIB) content decreased, and proportion of patients with multiple lesions in the first CT scan was higher in the progressive group, with significant differences ( P<0.05). Multivariate Logistic regression analysis showed that the distance from the center of cerebral contusion and laceration or hematoma to the nearest cortex<1 cm, plasma FIB<2 g/L, multiple lesions of cerebral contusion and laceration or hematoma on first CT scan were risk factors for progression in patients with cerebral contusion and laceration combined with hematoma formation ( OR=6.654, 95%CI: 1.391-35.089, P=0.025; OR=5.617, 95%CI: 1.136-28.022, P=0.034; OR=4.629, 95%CI: 1.178-20.071, P=0.031). Conclusion:The patients with short distance from the center of cerebral contusion and laceration or hematoma to the nearest cortex, low plasma FIB, and multiple lesions of cerebral contusion and laceration or hematoma on first CT scan are prone to have progressive cerebral contusion and hematoma formation.

El trauma ocular en la infancia / Ocular trauma in childhood

RESUMEN Objetivo: Determinar los resultados de la aplicación del ocular trauma score como herramienta de pronóstico visual en traumatismos. Métodos: Se realizó un estudio descriptivo longitudinal retrospectivo en el Servicio de Oftalmología del Hospital Pediátrico Provincial Docente "Eduardo Agramonte Piña", desde enero del año 2011 a enero de 2016. El universo estuvo conformado por 438 pacientes quienes recibieron ingreso hospitalario, y la muestra quedó conformada por 357 ojos de 356 pacientes con el diagnóstico de trauma ocular. Se analizaron las siguientes variables: etiología al ingreso, edad, sexo, topografía y tipo de lesión, evento traumático, agente causal, agudeza visual inicial según tipo de lesión y el pronóstico visual según el ocular trauma score. Resultados: El 81,3 por ciento de los pacientes ingresados presentaron etiología traumática; 64,6 por ciento fueron varones, con predominio del grupo de edad entre 5 y 9 años. Hubo una preponderancia de los traumas cerrados. Los accidentes recreativos fueron los más predominantes; los palos y las piedras resultaron el agente causal más frecuente y la agudeza visual final fue superior a la inicial. Conclusiones: La etiología traumática constituye la primera causa de ingreso en el Servicio de Oftalmología, donde se observa predominio de los pacientes entre 5 y 9 años, fundamentalmente del sexo masculino. Los traumas del globo ocular cerrado predominan sobre los del globo ocular abierto. Estos últimos presentan mayor afectación de la agudeza visual. El accidente recreativo y doméstico es más frecuente, así como los palos y las piedras como agentes causales. La mejoría de la agudeza visual fue significativa en este estudio, lo que se correspondió con la predicción sugerida por el ocular trauma score(AU)

ABSTRACT Objective: To determine the results of the application of the ocular trauma score as a tool for visual prognosis in traumatisms. Methods: Descriptive, longitudinal and retrospective study was carried out. The universe consisted of 438 patients who received hospital admission and the sample consisted of 357 eyes of 356 patients with the diagnosis of ocular trauma at admission. Different variables were analyzed: etiology at admission, age, sex, topography and type of injury, traumatic event, causal agent, initial visual acuity according to type of injury and visual prognosis according to ocular trauma score. Results: 81,3 percent of the patients admitted had traumatic etiology, 64.6 percent were males with predominance of the group aged between 5 and 9 years. There was a preponderance of closed traumas. The sticks and stones were the most frequent causal agent and the final visual acuity was superior to the initial one. Conclusions: The traumatic etiology is the first cause of admission in the Ophthalmology Service, where predominance is observed between 5 to 9 years, mainly of the male sex. The traumas to closed ocular globe predominate over those of open ocular globe presenting these last greater affectation of the visual acuity. The recreational and domestic accident is more frequent, as well as the sticks and stones as causal agents. The improvement in visual acuity is significant, corresponding with the prediction suggested by ocular trauma score(AU)

Alteraciones electrofisiológicas y/o bioquímicas del trauma cardíaco / Electrophysiological and/or biochemical alterations of cardiac trauma

Resumen El trauma cardíaco constituye una de las primeras causas de mortalidad en la población general. La gran mayoría son causados por accidentes automovilísticos. Su diagnóstico es difícil y requiere alto índice de sospecha en trauma cerrado. Posee un índice de mortalidad muy elevado, cercano al 76%. Existen varios métodos diagnósticos disponibles para facilitar su detección pero ninguno logra alcanzar una sensibilidad cercana al 100%. El trauma cardíaco contuso puede variar desde lesión cardíaca asintomática hasta ruptura cardíaca y muerte. Actualmente se utilizan marcadores bioquímicos como enzimas cardíacas, siendo la Troponina I la más específica; y electrofisiológicos como hallazgos en el electrocardiograma sugestivos de bloqueo de rama y taquicardia sinusal, siendo estos los más frecuentemente encontrados.

Abstract Heart trauma is one of the leading causes of mortality in the general population. The vast majority are caused by automobile accidents. Its diagnosis is difficult and requires a high index of suspicion in closed trauma. It has a very high mortality rate, close to 76%. There are several diagnostic methods available to facilitate its detection, but none can reach a sensitivity close to 100%. Contusive heart trauma can range from asymptomatic cardiac injury to cardiac rupture and death. Currently, biochemical markers are used as cardiac enzymes, with Troponin I being the most specific; and electrophysiological findings in the electrocardiogram suggestive of branch block and sinus tachycardia, these being the most frequently found.

Blunt cardiac injury: analysis of 348 patients / 中华急诊医学杂志

Objective@#To explore the early diagnosis, therapeutic methods and efficacy for blunt cardiac injury (BCI).@*Methods@#All BCI patients from September 2003 to August 2018 were studied retrospectively in respect of sex, age, cause of injury, diagnostic methods, therapeutic procedures, and outcome. The patients were divided into two groups: nonoperative group (n=305) and operative group (n=43). The two groups were compared and analyzed.@*Results@#Totally 348 BCI patients accounted for 18.3% of 1 903 patients with blunt thoracic injury (BTI), and the mortality rate was 10.1%. The main cause of injury was traffic accident with an incidence of 48.3%. The diagnostic methods included electrocardiogram (ECG), enzymes and troponin I, echocardiography, and CT scanning, or confirmed by emergency thoracatomy. In the nonoperative group, patients were mainly myocardial contusion, with a mortality rate of 6.9%. In the operative group, patients were mainly cardiac rupture and pericardial hernia, and the mortality was 32.6%. The incidence of negative ECG between the two groups was not significantly different (16.7% vs 11.6%, P>0.05). The incidence of shock and mortality in the operative group were significantly higher than those in the the nonoperative group (P<0.01). The number of death directly resulted from BCI in the operative group was greater than that in the nonoperative group (P<0.05).@*Conclusions@#For BTI patients, BCI must be highly suspected, and necessary examinations should be given. To manage myocardial contusion without surgery, it is necessary to protect the heart, alleviate edema of myocardium, and control arrhythmia with drugs. To deal with those patients requiring operation, early recognition and expeditious thoracotomy are essential.

Blunt cardiac injury: analysis of 348 patients / 中华急诊医学杂志

Objective To explore the early diagnosis,therapeutic methods and efficacy for blunt cardiac injury (BCI).Methods All BCI patients from September 2003 t9 August 2018 were studied retrospectively in respect of sex,age,cause of injury,diagnostic methods,therapeutic procedures,and outcome.The patients were divided into two groups:nonoperative group (n=305) and operative group (n=43).The two groups were compared and analyzed.Results Totally 348 BCI patients accounted for 18.3％ of 1 903 patients with blunt thoracic injury (BTI),and the mortality rate was 10.1％.The main cause of injury was traffic accident with an incidence of 48.3％.The diagnostic methods included electrocardiogram (ECG),enzymes and troponin I,echocardiography,and CT scanning,or confirmed by emergency thoracatomy.In the nonoperative group,patients were mainly myocardial contusion,with a mortality rate of 6.9％.In the operative group,patients were mainly cardiac rupture and pericardial hernia,and the mortality was 32.6％.The incidence of negative ECG between the two groups was not significantly different (16.7％ vs 11.6％,P＞0.05).The incidence of shock and mortality in the operative group were significantly higher than those in the the nonoperative group (P＜0.01).The number of death directly resulted from BCI in the operative group was greater than that in the nonoperative group (P＜0.05).Conclusions For BTI patients,BCI must be highly suspected,and necessary examinations should be given.To manage myocardial contusion without surgery,it is necessary to protect the heart,alleviate edema of myocardium,and control arrhythmia with drugs.To deal with those patients requiring operation,early recognition and expeditious thoracotomy are essential.

Effect of electroacupuncture of acupoints on the healthy limb (opposing needling) on acute skeletal muscle contusion in rats / 针刺研究

OBJECTIVE: To observe the therapeutic effect of electroacupuncture (EA) of "Zusanli" (ST36) and "Ashi"-point on the healthy side (opposing needling) on muscular injury and expression of myogenin (myoG) and fast myosin skeletal heavy chain (Fast MyHC) proteins in the gastrocnemius muscle (GM) tissues in skeletal muscle contusion rats，so as to explore its mechanism underlying improvement of skeletal muscle injury. METHODS: A total of 54 male SD rats were divided into normal control (n ＝ 6)，model (n＝24) and opposing needling (EA, n＝24) groups. The latter two groups were further randomized into 3, 5, 7 and 14 d subgroups (n＝6 per subgroup). The skeletal muscle contusion model of the hind-limb was established by using a self-made striking device. EA (1 Hz/3 Hz，1－2 mA) was applied to ST36 and "Ashi"-point on the uninjured side of the hind-limb for 15 min every time, once a day for 3, 5, 7 and 14 days, respectively. The injured GM was harvested on the 3rd, 5th, 7th and 14th day after muscular contusion. The morphological changes of the injured GM and the mean cross-sectional areas (CSAs) of the neonatal muscle cells were observed by microscope after H．E. staining. The immunoactivity of desmin protein (myogenic marker protein of myoblast cell) of GM was detected by immunofluorescence stain on the 7th day after injury, and the expression levels of myoG (on the 3rd and 5th day after injury) and fast MyHC protein of GM tissues (on the 7thand 14th day after injury) were detected by Western blot. RESULTS: H．E. staining of GS tissue showed fewer neuronal myocytes with disordered arrangement at different sizes, and appearance of some collagenous fibers among the mesenchyme on day 7 and 14 after muscular contusion, which was relatively milder in the EA group. In the EA group, the CSA values of the neonatal muscle cells were significantly larger than those in the model group on the day 7th (P0.05). On the 3rd and 5th day after muscular contusion, the expression level of myoG protein was significantly up-regulated in the model group compared with the normal control group (P<0.001), and significantly up-regulated in the EA group than that in the model group (P<0.001). On the 7th and14th day after contusion, the expression level of fast MyHC protein was significantly down-regulated in the model group relevant to the normal control group (P<0.001), and markedly up-regulated in the EA group relevant to the model group (P<0.01)．. CONCLUSION: EA of ST36 and "Ashi"-point on the contralateral limb can up-regulate the expression of myoG and fast MyHC proteins of GM in acute skeletal muscle contusion rats, which may contribute to its effect in promoting the repair of skeletal muscle injury.