脊髓损伤后凋亡调控基因Bcl-2、Bax的表达及意义

目的：观察探讨大白鼠脊髓损伤后细胞凋亡及调控基因Bcl-2、Bax的表达及意义。方法：28只SD大鼠随机分为7组，Allen’s法致伤脊髓，于术后4、8、24、48、72、168h采集脊髓标本，1组作为对照组，分别行HE染色、TUNEL染色和免疫组化技术检测Bcl-2、Bax的表达。结果：TUNEL染色显示有神经元和胶质细胞凋亡。Bcl-2在术后4h开始出现阳性表达，24h达高峰。Bax术后4h出现阳性表达，8h时达高峰。结论：脊髓损伤后存在神经元和胶质细胞的凋亡，Bcl-2、Bax基因对调控细胞凋亡可能具有重要作用。     

脊髓损伤后凋亡调控基因Bcl-2、Bax的表达及意义

目的 :观察探讨大白鼠脊髓损伤后细胞凋亡及调控基因Bcl -2、Bax的表达及意义。方法 :2 8只SD大鼠随机分为 7组 ,Allen′s法致伤脊髓 ,于术后 4、 8、 2 4、 48、 72、 168h采集脊髓标本 ,1组作为对照组 ,分别行HE染色、TUNEL染色和免疫组化技术检测Bcl -2、Bax的表达。结果 :TUNEL染色显示有神经元和胶质细胞凋亡。Bcl-2在术后 4h开始出现阳性表达 ,2 4h达高峰。Bax术后 4h出现阳性表达 ,8h时达高峰。结论 :脊髓损伤后存在神经元和胶质细胞的凋亡 ,Bcl-2、Bax基因对调控细胞凋亡可能具有重要作用。     

脊髓损伤后凋亡调控基因Bcl-2、Bax的表达及意义

目的:观察探讨大白鼠脊髓损伤后细胞凋亡及调控基因Bcl-2、-Bax的表达及意义.方法:28只SD大鼠随机分为7组,Allen‘s法致伤脊髓,于术后4、8、24、48、72、168h采集脊髓标本,1组作为对照组,分别行HE染色、TUNEL染色和免疫组化技术检测Bcl-2、Bax的表达.结果:TUNEL染色显示有神经元和胶质细胞凋亡.Bcl-2在术后4h开始出现阳性表达,24h达高峰.Bax术后4h出现阳性表达,8h时达高峰.结论:脊髓损伤后存在神经元和胶质细胞的凋亡,Bcl-2、Bax基因对调控细胞凋亡可能具有重要作用.     

大鼠急性脊髓损伤后细胞凋亡的时空分布特点

目的：研究急性脊髓损伤后神经细胞凋亡的分布特别及其意义。方法：Wistar雌性大白鼠54只，使用改良Alien法制作急性脊髓损伤模型，分别于术后l、4、8、24、72h、7、14及2ld处死取材(每时间点n=6)。应用HE染色及凋亡细胞原位末端标记法(TUNEL)对脊髓组织进行标记。结果：损伤后4h，在损伤段及邻近段可见末端标记的阳性神经细胞，损伤段灰质中阳性细胞数24h达高峰，72h白质中阳性胶质细胞数量达高峰。相邻节段阳性细胞数量在72h达高峰。灰质中神经元及胶质细胞均有阳性表达，但以胶质细胞为主。结论：脊髓损伤后神经细胞凋亡是继发损伤期的重要病理变化，并有其时相和空间分布特点.     

大鼠脊髓急性损务后神经细胞凋亡及相关基因表达

目的：研究脊髓急性损伤后神经细胞的凋亡及相关基因的表达,方法：大鼠脊髓（T8、T9）经中度压迫损伤后,分别在30min,2h,4h,8h,24h,48h,72h,7d,14d和21d处死取材（各间组n=4)。应用HE染色、免疫组化及凋亡细胞原位未端标记法对脊髓组织进行标记。结果：损伤4h后,在损伤段及邻近段可见末端标记阳性神经元,损伤段灰质中阳性细菌数8h达高峰,24h白质中阳性胶质细胞数量达高峰。相邻节段阳性细胞数72h达高峰。损伤后P53及Bax大量表达,而Bcl-2仅少量表达。结论：脊髓损伤后神经细胞的凋亡发损伤期的重要病理变化。     

大鼠脊髓急性损伤后神经细胞凋亡及相关基因表达△

目的研究脊髓急性损伤后神经细胞的凋亡及相关基因的表达.方法大鼠脊髓(T8、T9)经中度压迫损伤后,分别在30min、2h、4h、8h、24h、48h、72h、7d、14d和21d处死取材(各时间组n=4).应用HE染色、免疫组化及凋亡细胞原位末端标记法对脊髓组织进行标记.结果损伤4h后,在损伤段及邻近段可见末端标记阳性神经元,损伤段灰质中阳性细胞数8h达高峰,24h白质中阳性胶质细胞数量达高峰.相邻节段阳性细胞数72h达高峰.损伤后P53及Bax大量表达,而Bcl-2仅少量表达.结论脊髓损伤后神经细胞的凋亡是继发损伤期的重要病理变化.     

脊髓急性损伤后神经细胞凋亡的时相和空间分布特点

目的 研究脊髓急性损伤后神经细胞的凋亡及其时相和空间特点。方法 大鼠脊髓（T8,9）经中度压迫损伤后,分别在30min、2h、4h、8h、24h、48h、72h、7d、14d、和21d处死取材（n=4)。应用HE、Nissl染色及凋亡细胞原位末端标记法对脊髓组织进行标记。结果 损伤4h后,在损伤段及邻近段可见末端标记阳性神经细胞,损伤段灰质中阳性细胞数8h达高峰,24h白质中阳性胶质细胞数量达高峰。相邻节段阳性细胞数量在72h达高峰。阳性细胞以白质中胶质细胞为主,主要分布于相邻节段。结论 脊髓损伤后神经细胞凋亡是继发损伤期的重要病理变化,并有其时相和空间分布特点。     

犬马尾神经受压后腰骶髓中一氧化氮合酶活性与神经细胞凋亡的相关性

目的：研究马尾神经受压后一氧化氮合酶（NOS）活性变化与腰骶髓神经细胞凋亡的关系。方法：将27只健康家犬随机分为3组：A组21只，水囊置于椎管内并注水加压制成马尾神经压迫模型（马尾神经压迫组）；B组3只，置入水囊但未注水加压（假手术组）；C组3只（正常组）。A组再分为7组，即马尾神经持续受压4h、8h、12h、24h、48h、72h和168h组（n=3）。检测各组腰骶髓组织中的NOS活性变化，用TUNEL法标记凋亡神经元和神经胶质细胞，光镜（HE染色）和透射电镜观察细胞形态学改变。结果：B组和C组腰骶髓神经细胞形态未见异常，A组光镜及电镜观察结果均提示神经细胞发生凋亡。B组和C组未见凋亡神经元，A组于压迫后12h可见凋亡神经元，24～48h神经元凋亡最多。B组与C组腰骶髓组织中NOS活性比较无显著性差异（P〉0．05），A组于压迫12h后，NOS活性即明显增高，与B组和C组比较有显著性差异（P〈0．05），24～48h达到高峰，72h后开始下降。结论：犬马尾神经受压后腰骶髓组织中NOS活性增高，与相应神经元凋亡存在正相关。     

大鼠牵张性脊髓损伤后细胞凋亡及相关基因表达的实验研究

目的观察大鼠牵张性脊髓损伤后细胞凋亡现象,检测脊髓损伤后凋亡相关基因的表达。方法大鼠脊髓T13～L2经牵张损伤,皮层体感诱发电位(CSEP)监测P1N1波幅下降至术前波幅70%后,分别于术后30min、6h、1、4、7、14、21d处死大鼠,取材(n=4)。应用流式细胞仪、原位末端脱氧核糖核苷酸转移酶介导dUTP标记(TUNEL)技术观察脊髓细胞凋亡情况,用免疫组化检测p53、bax和bcl2的表达。结果流式细胞仪及TUNEL法检测显示,损伤组术后6h凋亡细胞开始增多,术后7d细胞凋亡率达高峰,随后开始回落,持续21d,与空白对照组及椎板切除组比较,差异有显著性意义(P<005,001)。TUNEL法染色显示,白质中出现大量胶质细胞凋亡。免疫组化染色显示损伤组术后6h开始,p53、bax和bcl2阳性表达开始增多,p53阳性细胞数术后4d达高峰,bax和bcl2术后7d达高峰,损伤组各时相点的阳性表达与空白对照组与椎板切除组比较差异有显著性意义(P<005,001)。结论牵张性脊髓损伤后存在细胞凋亡现象,从形态上看包括神经元和胶质细胞凋亡,细胞凋亡是牵张性脊髓损伤继发损害中细胞死亡的一种重要形式,也是继发损伤期的重要病理变化。凋亡相关基因p53、bax大量表达,可能在脊髓细胞凋亡过程中起重要作用。     

FTY720对大鼠急性脊髓损伤后神经功能恢复的影响及相关机制

目的:观察FTY720对大鼠急性脊髓损伤(ASCI)后神经功能的影响,并探讨其相关机制。方法:168只雌性SD大鼠,随机分成A、B、C三组,每组56只,A组(假手术组)大鼠麻醉后仅切除T9椎板,不打击脊髓,缝合后立即以0.3ml生理盐水灌胃。B、C组采用Allen′s法制作T9脊髓损伤模型,B组(对照组)以0.3ml生理盐水灌胃,C组(治疗组)以FTY720按3mg/kg生理盐水稀释至0.3ml灌胃。每组取8只大鼠分别于术后1d、3d、7d、14d、21d行斜板试验及BBB评分。分别于术后6h、12h、24h、48h、72h、7d、21d处死大鼠,每个时间点每组8只,取损伤段(A组取相应部位)脊髓行超薄切片,HE染色观察各组脊髓坏死情况、炎细胞浸润情况、胶质瘢痕形成情况及脊髓空洞大小,并计数各组术后12h淋巴细胞数、术后12h与72h炎性细胞、术后7d胶质瘢痕区细胞,计算伤后21d脊髓空洞面积与脊髓面积比值;取术后6h、12h、24h、72h的切片行SP免疫组化染色观察caspase-3表达及Tunel染色观察细胞凋亡情况,计算相应时间点免疫组化染色阳性细胞比值和凋亡指数。所有数据以SPSS 13.0进行统计学分析。结果:B、C两组各时间点斜板实验及BBB评分均较A组同时间点差(P<0.05),在术后1d时B、C组之间无显著性差异(P>0.05),术后3d、7d、14d、21d时C组优于B组(P<0.05)。HE染色结果显示A组各时间点脊髓形态正常;B、C组脊髓术后6h可见脊髓内出血、血肿形成,术后12h~48h脊髓进行性水肿、损伤中心区出现液化坏死,伴有炎细胞浸润,以中性粒细胞、淋巴细胞、单核细胞为主,至术后72h,损伤中心区形成无组织结构空洞,空洞周围有大量炎细胞浸润,以小胶质细胞/单核细胞为主;术后12h及72h,B组炎细胞浸润程度明显重于C组(P<0.05),术后12h C组淋巴细胞浸润程度相对B组明显减少(P<0.05),术后7d,脊髓水肿减轻,空洞周围形成胶质瘢痕,胶质瘢痕细胞计数B组明显大于C组(P<0.05),术后21d脊髓空洞形成,脊髓空洞比值B组明显大于C组(P<0.05)。SP免疫组化染色和Tunel染色结果显示A组各时间点几乎见不到caspase-3和细胞凋亡表达阳性细胞,B、C组脊髓损术后6h即可见凋亡细胞,到术后24h达高峰,而后随术后时间延长而逐渐减弱,但是仍然保持在较高水平;caspase-3表达与细胞凋亡同步,各时间点C组caspase-3表达阳性细胞比值和细胞凋亡指数均显著低于B组(P<0.05)。结论:FTY720可以显著改善大鼠ASCI后神经功能,其可能是通过抑制脊髓损伤后的炎症反应,减少caspase-3的表达及神经细胞凋亡,从而减轻脊髓继发性损伤。     

Penetrating ballistic-like frontal brain injury caused by a metallic rod

Summary  Penetrating non-missile intracranial injuries caused by metallic foreign bodies are very rare among the civilian population. We present a unique instance of a severe, high-energy, penetrating orbitocranial injury caused by a solid metallic rod that corresponded to the spray valve lever handle of a kitchen sink pre-rinse spray tap, which was fractured and projected at high speed for an unknown reason. To our knowledge, this is the first report of a high-energy, penetrating brain injury caused by such an object. After careful radiological evaluation of the shape and position of the foreign object, a combined right frontal craniotomy and supraorbital osteotomy was performed in order to achieve safe removal of the metal bar. Successful surgical treatment of an orbitocranial injury caused by a similar object has not previously been reported.     

Abdominal vascular injuries: Blunt vs. penetrating

Introduction: Abdominal vascular injuries (AVIs) remain a great challenge since they are associated with significant mortality. Penetrating injury is the most common cause of AVIs; however, some AVI series had more blunt injuries. There is little information regarding differences between penetrating and blunt AVIs. The objective of the present study was to identify the differences between these two mechanisms in civilian AVI patients in terms of patient’s characteristics, injury details, and outcomes.Method: From January 2007 to January 2016, we retrospectively collected the data of AVI patients at King Chulalongkorn Memorial hospital, including demographic data, details of injury, the operative managements, and outcomes in terms of morbidity and mortality. The comparison of the data between blunt and penetrating AVI patients was performed.Results: There were 55 AVI patients (28 blunt and 27 penetrating). Majority (78%) of the patients in both groups were in shock on arrival. Blunt AVI patients had significantly higher injury severity score (mean(SD) ISS, 36(20) vs. 25(9), p?=?0.019) and more internal iliac artery injuries (8 vs. 1, p?=?0.028). On the other hand, penetrating AVI patients had more aortic injuries (5 vs. 0, p?=?0.046), and inferior vena cava injuries (7 vs. 0, p?=?0.009). Damage control surgery (DCS) was performed in 45 patients (82%), 25 in blunt and 20 in penetrating. The overall mortality rate was 40% (50% in blunt vs. 30% in penetrating, p?=?0.205).Conclusions: Blunt AVI patients had higher ISS and more internal iliac artery injuries, while penetrating AVI patients had more aortic injuries and vena cava injuries. Majority of AVI patients in both groups presented with shock and required DCS.     

Lisfranc injuries: Incidence,mechanisms of injury and predictors of instability

BackgroundIn Lisfranc injuries the stability of the tarsometatarsal joints guides the treatment of the injury. Determining the stability, especially in the subtle Lisfranc injuries, can be challenging. The purpose of this study was to identify incidence, mechanisms of injury and predictors for instability in Lisfranc injuries.MethodsEighty-four Lisfranc injuries presenting at Oslo University Hospital between September 2014 and August 2015 were included. The diagnosis was based on radiologically verified injuries to the tarsometatarsal joints. Associations between radiographic findings and stability were examined.ResultsThe incidence of Lisfranc injuries was 14/100,000 person-years, and only 31% were high-energy injuries. The incidence of unstable injuries was 6/100,000 person–years, and these were more common in women than men (P = 0.016). Intraarticular fractures in the two lateral tarsometatarsal joints increased the risk of instability (P = 0.007). The height of the second tarsometatarsal joint was less in the unstable injuries than in the stable injuries (P = 0.036).ConclusionThe incidence of Lisfranc injuries in the present study is higher than previously published. The most common mechanism of injury is low-energy trauma. Intraarticular fractures in the two lateral tarsometatarsal joints, female gender and shorter second tarsometatarsal joint height increase the risk of an unstable injury.Level of EvidenceLevel III, cross-sectional study.     

Penetrating Neck Injury: A Case Report and Review of Management

Penetrating neck injury constitutes 5–10 % of all cases seen in the emergency room. As surgeons we must be prepared to manage these cases. After stabilizing the general condition of the patient the neck injuries are assessed. Management has changed from routine exploration to selective exploration. Injury to aerodigestive tract and vessels are commonly seen.     

Primary brain stem lesions caused by closed head injuries

Traumatic lesions of the brain stem are of two types: primary, which are considered to be caused at the moment of impact, and secondary, associated with supratentorial mass lesion. Of the 239 patients with a serious head injury who showed a severe disturbance of consciousness upon admisision and who had CT scan carried out immediately, 21 cases were considered to have a primary brain stem lesion with initial CT scan. A primary brain stem lesion was found in 21 of 239 (8.8%) of patients with serious head injury. Their injuries were caused primarily by traffic accidents. Sixteen of the 21 cases showed not only brain stem lesions but also other brain injuries such as cerebral contusion of the white and gray matter, callosal injury, intraventricular hemorrhage, and subarachnoid hemorrhage, which are considered to be caused by a diffuse shearing injury. Five cases who showed a single injury to the brain stem with no other brain lesions were considered to have a pure brain stem lesion. Primary brain stem lesions were observed on the dorsal side of the midbrain, where they can be differentiated from secondary brain stem lesions. These lesions are considered to result from the shearing mechanism in and around the brain stem very close to the tentorial edge, or to an injury of the lower brain stem by hyperextension of the cervical vertebrae. The prognosis of patients with a primary brain stem lesion was usually unfavorable, except in those with a single brain stem lesion.     

Genitourinary trauma

Genitourinary trauma occurs in about 10–20% of multiply injured patients and occurs in conjunction with other life-threatening injuries that require immediate attention. Initial assessment should include securing the airway, controlling external bleeding and resuscitation of shock. In many cases the patient is attended by a team where examination and resuscitation is carried out simultaneously. Recognition of genitourinary trauma with appropriate investigations is necessary to select patients for immediate intervention or conservative measures. We discuss the assessment and management of these patients.     

Glutaraldehyde-induced bowel injury after laparoscopy

We document the sequelae of the inadvertent introduction of glutaraldehyde into the peritoneal cavity. It describes the clinical course, progressive histological changes to the bowel at different periods over the course of 1 year, and what long-term morbidity remains. The chemical structure, effects, and pathogenesis of glutaraldehyde are described as well as suggestions for avoiding similar problems in the future.