2014年 · 第17卷第01期

Abstract：Objective:To investigate the neuroprotective effects of glycyrrhizin (Gly) as well as its effect on expression of high-mobility group box 1 (HMGB 1) in rats after traumatic brain injury (TBI).Methods:Male Sprague-Dawley rats were randomly divided into three groups:sham group,TBI group,and TBI+Gly group (n=36 per group).Rat TBI model was made by using the modified Feeney's method.In TBI+Gly group,Gly was administered intravenously at a dosage of 10 mg/kg 30 min after TBI.At 24 h after TBI,motor function and brain water content were evaluated.Meanwhile,HMGB 1/HMGB 1 receptors including toll-like receptor 4 (TLR4) and receptor for advanced glycation end products (RAGE)/nuclear factor-κ B(NF-κ B) signaling pathway and inflammatory cytokines in the injured brain tissues were detected using quantitative real-time polymerase chain reaction,western blot,electrophoretic mobility shift assay and enzyme-linked immunosorbent assay.Furthermore,HMGB 1,RAGE and TLR4 immunohistochemistry and apoptosis were analyzed.Results:Beam walking performance impairment and brain edema were significantly reduced in TBI+Gly group compared with TBI group; meanwhile,the over-expressions of HMGB 1/HMGB 1 receptors (TLR4 and RAGE)/NF-κB DNA-binding activity and inflammatory cytokines were inhibited.The percentages of HMGB 1,RAGE and TLR4positive cells and apoptotic cells were respectively 58.37％±5.06％,54.15％±4.65％,65.50％± 4.83％,52.02％± 4.63％ in TBI group and 39.99％±4.99％,34.87％±5.02％,43.33％±4.54％,37.84％±5.16％ in TBI+Gly group (all P＜0.01 compared with TBI group).Conclusion:Gly can reduce secondary brain injury and improve outcomes in rat following TBI by down-regulation of HMGB 1/HMGB 1 receptors (TLR4 and RAGE)/NF-κ B-mediated inflammatory responses in the injured rat brain。

Abstract：Multiple volar dislocations of carpometacarpal (CMC) joints are uncommon and have been reported rarely.A 25 years old male presented with injury to his left hand 6 days following a road traffic accident.Clinical examination revealed gross swelling of the hand and diffuse tenderness over the carpometacarpal area.His radiographs of the hand showed volar dislocation of the second,third and fourth CMC joints in association with an extra-articular fracture of the base of thumb metacarpal.He was treated by open reduction and percutaneous fixation using Kirschner wires.The functional results were excellent at one year follow-up。

Abstract：Objective:To assess the effect of cyclosporine A (CsA) loaded in chitosan conduit on bridging the sciatic nerve defects in a rat model.Methods:A 10 mm sciatic nerve defect was bridged using a chitosan conduit filled with 10 μl carrier-drug dilution (10 μg/L CsA).In control group,the conduit was filled with the same volume of carrier dilution alone.The regenerated fibers were studied 4,8 and 12 weeks after surgery.Results:The functional study confirmed faster recovery of the regenerated axons in treatment group than control group (P＜0.05).There was statistically significant difference of the gastrocnemius muscle weight ratios between treatment and control groups (P＜0.05).Morphometric indices of regenerated fibers showed that the number and diameter of the myelinated fibers in CsA-treated animals were significantly higher than those in control group.In immunohistochemistry,the location of reactions to S-100 in CsA group was clearly more positive than control group.Conclusion:CsA loaded in a chitosan conduit results in improvement of functional recovery and quantitative morphometric indices of sciatic nerve.It is easily available without any complications compared with its systemic administration。

Abstract：Objective:An accurate scoring system for intra-abdominal injury (IAI) based on clinical manifestation and examination may decrease unnecessary CT scans,save time,and reduce healthcare cost.This study is designed to provide a new scoring system for a better diagnosis of IAI after blunt trauma.Methods:This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT) admitted to the emergency department (ED) of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital.All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol.Diagnosis was done according to CT scan findings,which was considered as the gold standard.Data were gathered based on patient's history,physical exam,ultrasound and CT scan findings by a general practitioner who was not blind to this study.Chisquare test and logistic regression were done.Factors with significant relationship with CT scan were imported in multivariate regression models,where a coefficient (β) was given based on the contribution of each of them.Scoring system was developed based on the obtained total β of each factor.Results:Altogether 261 patients (80.1％ male) were enrolled (48 cases of IAI).A 24-point blunt abdominal trauma scoring system (BATSS) was developed.Patients were divided into three groups including low (score＜8),moderate (8≤score＜12) and high risk (score ≥ 12).In high risk group immediate laparotomy should be done,moderate group needs further assessments,and low risk group should be kept under observation.Low risk patients did not show positive CT-scans (specificity 100％).Conversely,all high risk patients had positive CT-scan findings (sensitivity 100％).The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS (sensitivity=99.3％).Conclusion:The present scoring system furnishes a high precision and reproducible diagnostic tool for BAT detection and has the potential to reduce unnecessary CT scan and cut unnecessary costs。

Abstract：Objective:Detection of abdominal injury is a very important component in trauma management,so a precise assessment of liver and spleen injuries including their severity degree is necessary.There is a good case to believe that in emergency situations the radiologists' performance may profit from a systematic approach using established scoring systems.Score systems as the organ injury scale (OIS) drawn up by the American Association for the Surgery of Trauma are a valuable guidance for objective trauma assessment.Aim of this study was to evaluate retrospectively whether a structured approach using the OIS may help improve trauma assessment.Methods:Fifty-three patients,38 male and 15 female who underwent CT and laparotomy after abdominal trauma were included in this study.The laparotomy was performed by experienced surgeons with a minimum experience of 6 years.While the original CT reports were written by different radiologists with a minimum experience of 3 years,and then a radiologist with experience of 4 years reviewed the same original CT pictures,resulting in the structured report.Both the original and structured CT results on liver and spleen injuries were transferred into OIS grades.Finally,the initial and structured CT results were compared with the intraoperative findings gathered from the surgery report.Results:Regarding the original CT report we found a mean divergence of 0.68±0.8 (r=0.45) to the OIS finding in the surgery report for liver injuries (0.69±1.17 for spleen injuries; r=0.69).In comparison with the structured approach,where we detected a divergence of 0.8±0.68; r=0.63 (0.47±0.77for spleen injuries; r=0.91),there was no significant difference.However we detected a lower rate of over-diagnosis in structured approaches.Conclusion:Our study shows that a structured approach to triage abdominal trauma using an imaging checklist does not lead to a significantly higher detection rate,but a nonsignificant trend to reduce the rate of overdiagnoses,thus being more precise in grading the severity grade.Concerning the bias by retrospective study design,further prospective investigations are needed to evaluate the impact of trauma scores on the workflow in emergency department procedure as structured reporting systems are a valuable guidance in other radiological disciplines。

Abstract：Objective:To determine the frequency of adrenal injuries in patients presenting with blunt abdominal trauma by computed tomography (CT).Methods:During a 6 month period from January 1,2011 to June 30,2011,82 emergency CT examinations were performed in the setting of major abdominal trauma and retrospectively reviewed for adrenal gland injuries.Results:A total of 7 patients were identified as having adrenal gland injuries (6 males and 1 female).Two patients had isolated adrenal gland injuries.In the other 5 patients with nonisolated injuries,injuries to the liver (1 case),spleen (1 case),retroperitoneum (2 cases) and mesentery (4 cases)were identified.Overall 24 cases with liver injuries (29 ％),11cases with splenic injuries (13％),54 cases with mesenteric injuries (65％),14 cases (17％) with retroperitoneal injuries and 9 cases with renal injuries were identified.Conclusion:Adrenal gland injury is identified in 7patients (11.7％) out of a total of 82 patients who underwent CT after major abdominal trauma.Most of these cases were nonisolated injuries.Our experience indicates that adrenal injury resulting from trauma is more common than suggested by other reports.The rise in incidence of adrenal injuries could be attributed to the mode of injury。

Abstract：Objective:Considering the difficulty in classifying some cases with eye trauma by Birmingham Eye Trauma Terminology (BETT) in our epidemiological study,we introduce a new classification for epidemiological study of mechanical eye injuries based on BETT.Methods:A retrospective investigation was carried out in 31 hospitals from January 2005 to December 2010.All medical records of inpatients with eye injuries were reviewed.A total of 10 718 patients (11 227 eyes) were diagnosed as mechanical eye injuries.All mechanical eye injuries were tried to be classified using BETT.While some eye injuries were difficult to categorize.We recorded the injury type and case number.A new classification based on BETT was also used for the same project.Results:Of 10 718 patients (11 227 eyes) with mechanical eye injuries,the following cases cannot be classified by BETF:1 488 patients (1 559 eyes) with merely orbital or ocular adnexa injury,1 961 (2 054) globe injuries associated with orbital or ocular adnexa injury,271 (284) ocular surface foreign body (OSFB) or ocular wall foreign body (OWFB),77 (89) contusion,9 (11) lamellar laceration associated with OSFB or OWFB,29 (30) rupture associated with OSFB,OWFB or intraocular foreign body and 60 (62) laceration associated with OSFB or OWFB.While according to our new classification,all eye injuries can be categorized without any difficulty.Conclusion:Difficulty in classifying some eye injuries in epidemiological study by BETT brings some trouble to our study,which can be solved by our new eye injury classification to some extent.It is hoped that other ophthalmologists present better ones to make the classification more perfect。

Abstract：Laparotomy or thoracolaparotomy is a traditional management approach for thoracoabdominal impalement injury associated with major liver and diaphragmatic injuries.We successfully treated the impalement injury with minimally invasive management.A male was brought to our trauma centre with the 15 cm long handle of the knife protruded from right lateral thoracoabdominal region.CT scan revealed that the knife blade traversed through the right costophrenic recess into segment 8 of the liver.There was an intraparenchymal haematoma and a collection of fluid in the abdominal cavity.The conservative management plan consisting of removing the impaled knife,observing,monitoring and managing complications was undertaken.A multidisciplinary approach to manage a parent with less invasive techniques yielded a good outcome.This management option may be considered as an alternative for open surgery for hemodynamically stable patients in experienced centres。

Abstract：A 77-year-old man who had underwent orthopedic surgery 17 days ago due to his left femur fracture caused by a pedestrian-car accident came to our emergency department with the chief complaint of a 2 days history of sore throat and cough and also swelling of eyelids.He had no respiratory distress or any other life-threatening symptoms.Subsequent physical examination revealed remarkable edema and crepitus over the whole face,neck,proximal upper limbs and the anterior and posterior chest regions,and also bilateral hyperresonance was detected in pulmonary auscultation.The imaging studies showed pneumomediastinum and bilateral subcutaneous emphysema.The diagnosis of pneumomediastinum and mild left pneumothorax and massive subcutaneous emphysema was definitely made.He underwent bilateral tube thoracostomy by using a 32 French chest tube under local anesthesia in the fifth intercostal space on the anterior axillary line.The patient was discharged with no complications 10 days postoperatively。

Abstract：Fractures of the paediatric talus are infrequent injuries,most complicated by posttraumatic arthrosis and avascular necrosis in the course of treatment.Nonunion in children has not been reported before in literature.We report a case of a 12-year-old boy who had a nonunion of Hawkins type Ⅱ fracture of talar neck.The nonunion was treated surgically with a good clinical outcome.The goals of management in nonunion of paediatric talar neck fracture are different from those in fresh fractures.A suboptimal reduction should be acceptable without trying a radical surgery which may cause further impairment。

Abstract：Retrieval of a broken guide wire transfixing the acetabulum or with intrapelvic migration is challenging and frustrating for surgeons.We here present a case report on a method to remove a broken guide wire transfixing the acetabulum through the proximal hole of recon nail using a grasping forceps.This method is little invasive,easy,time-saving and without need for changing the inital fixation。

Abstract：Fracture of the proximal humerus metaphysis with coexistent dislocation of the shoulder in children is a rare injury.The injury often occurs as a consequence of high velocity trauma.Most fractures of the proximal humerus commonly associated with the epiphysis in children can be treated with closed reduction.We presented a case of 5-year-old girl who sustained this type of fracturedislocation of the shoulder.Open reduction and internal fixation with multiple smooth K-wires was performed.At two years follow-up,the patient was pain free and regained full range of motion。