Neonatal spinal cord injury

Neonatal Spinal Cord Injury (SCI) is well described in the literature, though its diagnosis is often delayed or missed in the neonatal period. We present a neonate who was referred with upper gastrointestinal bleed and a diagnosis of spinal cord injury was subsequently made clinically and confirmed radiologically.     

Neurogenic Stunned Myocardium and Transient Severe Tricuspid Regurgitation in a Child Following Nonaccidental Head Trauma

Neurogenic stunned myocardium is widely reported in the adult literature and is typically associated with subarachnoid hemorrhage. We present a case of neurogenic stunned myocardium and transient severe tricuspid regurgitation in a 7-month-old infant following nonaccidental head trauma.     

A key to effective control of childhood injuries

Abstract Injuries account for 50% of deaths in Australian children aged 1-14 years, and are a major cause of hospital admission and disability. Injury surveillance systems involving the establishment of ongoing, systematic collection and analysis of data relevant to injury prevention and trauma management have a critical role in the effective control of the injury pandemic. Contemporary Australian initiatives including the establishment of the National Injury Surveillance and Prevention Project, new national public health programmes and research initiatives have the potential to establish a new wave of injury control programmes on a firm scientific base.     

Neonatal spinal cord injury

Neonatal spinal cord injury (SCI) is well described in the literature, though its diagnosis is often delayed or missed in the neonatal period. We present a neonate who was referred with upper gastrointestinal bleed and a diagnosis of spinal cord injury was subsequently made clinically and confirmed radiologically.     

Risk and prevention of unintentional injuries in children and young people with attention-deficit/hyperactivity disorder

Injuries among children and young people are a leading cause of morbidity and mortality in the UK and globally. Attention-deficit/hyperactivity disorder (ADHD) is an important neurodevelopmental disorder which can be present from preschool age but is generally under-recognised. Children and young people with ADHD are at increased risk of a variety of unintentional injuries. However, interventions to offer safety advice, assessments and safety equipment can help to improve home safety practices and reduce injuries. Clinician contacts with children and young people with ADHD are an important opportunity to recognise injury risk and offer appropriate advice and input. This article discusses the risks, mechanisms, costs and prevention advice for unintentional injuries in children and young people with ADHD.     

Trends in childhood injury mortality in Canada, 1979–2002

OBJECTIVE: To examine national trends in mortality rates for injuries among Canadian children younger than 15 years in 1979-2002. METHODS: Data on injury deaths were obtained from the Canadian Vital Statistics system at Statistics Canada. Injuries were classified using the codes for external cause of injury and poisoning (E-codes) by intent and by mechanism. Mortality rates were age adjusted to the 1990 world standard population. Negative binomial regression was used to estimate the secular trends. RESULTS: Annual mortality rates for total and unintentional injuries declined substantially (from 23.8 and 21.7 in 1979 to 7.2 and 5.8 in 2002, respectively), whereas suicide deaths among children aged 10-14 showed an increasing trend. All Canadian provinces and territories showed a decreasing trend in mortality rates of total injuries. Motor vehicle related injuries were the most common cause of injury deaths (accounted for an average of 36.4% of total injury deaths), followed by suffocation (14.3%), drowning (13.5%), and burning (11.1%); however, suffocation was the leading cause for infants. The number of potential years of life lost due to injury before age 75 decreased from 89 343 in 1979 to 27 948 in 2002 for children aged 0-14 years. CONCLUSIONS: During the period 1979-2002, there were dramatic decreases in childhood mortality for total injuries and unintentional injuries as well as various degrees of reduction for all causes of injury except suffocation in children aged 10-14 years and drowning in infants. The reason for the reduction in injury mortality might be multifactoral.     

肾损伤分子-1在急性缺血缺氧再灌注大鼠肾组织中的表达及意义

目的 观察肾损伤分子-1(kidney injury molecule-1,KIM-1)在急性缺血缺氧再灌注肾损伤(acute ischemia reperfusion kidney injury,AIKI)大鼠肾组织中的表达及分布规律,探讨其在诊断急性肾损伤(acute kidney injury,AKI)中的价值.方法 采用清洁级SD大鼠128只,随机分为对照组和模型组,模型组按国际标准建立大鼠AIKI模型,分别于2h、6h、24h、48h、72h、1周、2周、4周处死(n=8),取肾组织,常规HE染色,参照Sayhan等标准对肾小管间质损伤进行半定量评分;免疫组织化学、Western blot法检测KIM-1蛋白的表达及分布;生化法测定血清肌酐(serum creatinine,Scr)水平.结果 (1)大鼠缺血再灌注后2h即出现明显肾小管间质损伤,随着再灌注时间延长损伤加重,48h达高峰后逐渐减轻,但仍高于对照组(P<0.01);(2)Western blot和免疫组织化学检测发现,缺血再灌注后2h肾组织KIM-1的表达明显升高,KIM-1表达水平与肾小管间质损伤评分呈显著正相关(r=0.887,P=0.003);(3)大鼠缺血再灌注后2h Scr明显升高,48h达到最高值后降至正常,其升高与肾小管间质损伤评分无相关性(r=0.280,P=0.502).结论 AIKI模型中大鼠肾组织KIM-1蛋白表达水平显著增加,其表达水平与肾小管间质损伤评分呈正相关,与Scr相比,KIM-1可能为更准确地反映肾损伤情况的指标.     

Protective effects of recombinant human interleukin-4 administration on the hypoxia-reoxygenation-induced gastric and intestinal injury in rat pups

The aim of this study was to determine the effects of recombinant human interleukin-4 (rhIL-4) on the hypoxia-induced gastric and intestinal injury in the rat pups. The study was performed on 401-day-old Sprague Dawley rat pups. Group 1 (sham) rats served as nonhypoxic controls. Group 2 (rhIL-4 treated /control) rats were administrated rIL-4 alone. Group 3 (hypoxia-reoxygenation [H-O]/untreated) rats were subjected to H-O and were then returned to their mothers. Group 4 (H-O/rhIL-4 treated) rats were subjected to H/O and were treated with rhIL-4 for the next 3 days. All animals were killed on day 4 and gastric and intestinal specimens were obtained to determine the tissue level of malondialdehyde (MDA) and histological changes.

In group 3 MDA levels were significantly increased compared with groups 1,2, and 4. In group 4, MDA levels were not significantly different compared with group 3. The gastric and intestinal injury score were increased significantly in the group 3 and 4 rats compared with group 1 and 2. However, this increase was lower in group 4 rats compared with group 3. In group 3, after hypoxia following reoxygenation, exfoliation and necrosis of superficial cells, blood cell infiltration, and structural alterations on the two-third parts of the glandular pits, and bleeding erosions developed in all stomachs. Treatment with rhIL-4 produced a reduction of exfoliation of superficial cells, hemorrhage, and blood cell infiltration. In group 3 animals, destruction of villi and crypts of ileum and in some cases extension to the muscularis were noticed. In contrast, in the rats treated with rhIL-4, lesions were limited essentially to the very tips of the villi. This study found beneficial effects of rhIL-4 in an experimental model of hypoxia-induced gastric and intestinal injury.     

肾脏缺血再灌注损伤的免疫学机制研究进展

固有免疫和适应性免疫参与肾脏缺血再灌注损伤(ischemia-reperfusion injury,IRI).在IRI急性期,肾血管内皮细胞黏附分子表达和血管通透性增加;肾小管上皮细胞补体C3沉积和Toll样受体2、4表达增加;树突状细胞早期活化导致中性粒细胞、巨噬细胞、自然杀伤细胞、CD4+T细胞和B细胞等迁移到缺血后肾脏.可溶性免疫分子(如补体活化产物、细胞因子和趋化因子)参与肾脏IRI急性损伤和(或)修复.Foxp3+调节性T细胞和旁路活化的巨噬细胞参与肾脏IRI修复;而B细胞限制IRI修复.     

Distribution of spinal fractures in children: does age,mechanism of injury,or gender play a significant role?

Background The distribution of fractures in the spine reported in the literature is quite variable. Application of such data to the pediatric population needs to take into account differences between children and adults, including overall decreased fracture frequency in children, developmental and physiological differences, and mechanism of injury. Knowledge of specific regions of injury may alter search patterns and protocols.Objective To determine if the distribution of spinal injuries in pediatric patients is related to age, mechanism of injury, or gender.Patients and methods All pediatric patients (<18 years old) referred to our trauma service over a 5-year period were retrospectively reviewed. All patients with vertebral fracture and/or neurological injury were included. The levels of the spinal fractures were tabulated. Correlation was then made with age, gender, and mechanism of injury (motor vehicle accident versus non-motor vehicle accident).Results Of the 2614 pediatric patients, 84 sustained vertebral fracture and 50 had neurological injury without radiographic abnormality. A total of 164 fractures were identified. The thoracic region (T2-T10) was most commonly injured, accounting for 47 fractures (28.7%) followed by the lumbar region (L2-L5) with 38 fractures (23.2%), the mid-cervical region with 31 fractures (18.9%), the thoracolumbar junction with 24 fractures (14.6%), the cervicothoracic junction with 13 fractures (7.9%), and the cervicocranium with 11 fractures (6.7%). There was no relationship to gender or mechanism of injury.Conclusions Regardless of gender or mechanism of injury, the thoracic spine (T2-T10) is the most common region of fracture in pediatric trauma patients.     

The expression of NF-κB and TGF-β1 in the injured kidneys of neonate rats with endotoxemia

Objective To investigate the mechanism of the kidney injure in the newborn rats with endotoxemia.Methods Eighty Wistar rats aged 7 days were randomly divided into 2 groups:control group (intraperitoneal injection of saline of 0.1 ml;n = 40),lipopolysaccharide(LPS) group(intraperitoneal injection of LPS of 5 mg/kg;n =40).The rats in either group were killed at 1 h,4 h,8 h and 12 hours after intraperitoneal injection,respectively.The expressions of NF-κB and TGF-β1 in the kidney were detected by using the immunohistochemical assay.Renal ultrastructural changes was observed with a CM100 Philips electron microscope.Results The NF-κB in control group had no expression.NF-κB in LPS group mainly expressed in the renal tubular epithelial cell,increased at 1 h after test and peaked at 8 h,and slightly descended at 12 h.The expression of TGF-β1 in control group was slight,and had not show significant difference from control group at 1 h,4 h and 8 h,but significantly higher than that in control group at 12 h.In LPS group,newborn rat renal glomerular basement membrane was complete,part epithelial cell foot processes were fused and renal tubules epithelial cell mild mitochondria vacuolization was found at 4 h.Renal glomeruli epithelial cell foot processes obvious confluenced,quantities of mesangial cells mitochondria vacuole,and renal tubules epithelial cell mitochondria expanded to bubbles at 12 h.Conclusion The NF-κB involves in the pathogenesis of kidney damage induced by endotoxemia,but TGF-β1 may help to repair the damaged kidney,and may repress the production of NF-κB.     

The expression of NF-κB and TGF-β1 in the injured kidneys of neonate rats with endotoxemia

Objective To investigate the mechanism of the kidney injure in the newborn rats with endotoxemia.Methods Eighty Wistar rats aged 7 days were randomly divided into 2 groups:control group (intraperitoneal injection of saline of 0.1 ml;n = 40),lipopolysaccharide(LPS) group(intraperitoneal injection of LPS of 5 mg/kg;n =40).The rats in either group were killed at 1 h,4 h,8 h and 12 hours after intraperitoneal injection,respectively.The expressions of NF-κB and TGF-β1 in the kidney were detected by using the immunohistochemical assay.Renal ultrastructural changes was observed with a CM100 Philips electron microscope.Results The NF-κB in control group had no expression.NF-κB in LPS group mainly expressed in the renal tubular epithelial cell,increased at 1 h after test and peaked at 8 h,and slightly descended at 12 h.The expression of TGF-β1 in control group was slight,and had not show significant difference from control group at 1 h,4 h and 8 h,but significantly higher than that in control group at 12 h.In LPS group,newborn rat renal glomerular basement membrane was complete,part epithelial cell foot processes were fused and renal tubules epithelial cell mild mitochondria vacuolization was found at 4 h.Renal glomeruli epithelial cell foot processes obvious confluenced,quantities of mesangial cells mitochondria vacuole,and renal tubules epithelial cell mitochondria expanded to bubbles at 12 h.Conclusion The NF-κB involves in the pathogenesis of kidney damage induced by endotoxemia,but TGF-β1 may help to repair the damaged kidney,and may repress the production of NF-κB.     

Determining objective injury prevention priorities.

BACKGROUND AND OBJECTIVE: Finite injury prevention resources make the establishment of prevention priorities essential. Toward this end, the US National Trauma Data Bank (NTDB) for 2000 to 2004 was accessed and four injury prevention priority scores (one previously defined and three new scores) were computed. METHODS: An injury prevention priority score (IPPS) was calculated based on the frequency of an injury mechanism and the median injury severity score. In addition, a mortality priority score (Mort-PS), a hospital charge priority score (Charge-PS), and a years of potential life lost (YPLL-PS) priority score were calculated for the 13 most common injury mechanisms. RESULTS: There was variability across the four scores, but motor vehicle traffic, firearm related, and fall injuries ranked high on all four of the priority criteria. Multiple criteria should be considered when assessing injury burden. CONCLUSIONS: The methods presented here can help prioritize injuries and support more objective public policies.     

小儿闭合性胰,十二指肠严重外伤的外科处理：附12例报告

探讨小儿闭合性胰、十二指肠严重外伤的诊治特点。本组小儿闭合性胰断裂２例，十二指肠破裂４例，胰、十二指肠复合伤６例。手术探查并采取远端胰切除及十二指肠“憩室化”（Ｂｅｒｎｅ１９７４年首先提出，其手术方法为：修补十二指肠损伤，切除胃窦，关闭十二指肠，行胃空肠吻合术。同时可行胆总管Ｔ型管引流，再作十二指肠插管造口术及双侧迷走神经干切断术）。３例术前确诊，另９例为手术探查后确诊。治愈８例，死亡４例，其中２例与术式选择不当有关。术前确诊困难，主张早期探查。推荐注射美蓝法寻找断裂胰管。根据不同伤情选择创伤小、安全可靠的术式。     

The expression of NF-κB and TGF-β1 in the injured kidneys of neonate rats with endotoxemia

Objective To investigate the mechanism of the kidney injure in the newborn rats with endotoxemia.Methods Eighty Wistar rats aged 7 days were randomly divided into 2 groups:control group (intraperitoneal injection of saline of 0.1 ml;n = 40),lipopolysaccharide(LPS) group(intraperitoneal injection of LPS of 5 mg/kg;n =40).The rats in either group were killed at 1 h,4 h,8 h and 12 hours after intraperitoneal injection,respectively.The expressions of NF-κB and TGF-β1 in the kidney were detected by using the immunohistochemical assay.Renal ultrastructural changes was observed with a CM100 Philips electron microscope.Results The NF-κB in control group had no expression.NF-κB in LPS group mainly expressed in the renal tubular epithelial cell,increased at 1 h after test and peaked at 8 h,and slightly descended at 12 h.The expression of TGF-β1 in control group was slight,and had not show significant difference from control group at 1 h,4 h and 8 h,but significantly higher than that in control group at 12 h.In LPS group,newborn rat renal glomerular basement membrane was complete,part epithelial cell foot processes were fused and renal tubules epithelial cell mild mitochondria vacuolization was found at 4 h.Renal glomeruli epithelial cell foot processes obvious confluenced,quantities of mesangial cells mitochondria vacuole,and renal tubules epithelial cell mitochondria expanded to bubbles at 12 h.Conclusion The NF-κB involves in the pathogenesis of kidney damage induced by endotoxemia,but TGF-β1 may help to repair the damaged kidney,and may repress the production of NF-κB.     

The expression of NF-κB and TGF-β1 in the injured kidneys of neonate rats with endotoxemia

Objective To investigate the mechanism of the kidney injure in the newborn rats with endotoxemia.Methods Eighty Wistar rats aged 7 days were randomly divided into 2 groups:control group (intraperitoneal injection of saline of 0.1 ml;n = 40),lipopolysaccharide(LPS) group(intraperitoneal injection of LPS of 5 mg/kg;n =40).The rats in either group were killed at 1 h,4 h,8 h and 12 hours after intraperitoneal injection,respectively.The expressions of NF-κB and TGF-β1 in the kidney were detected by using the immunohistochemical assay.Renal ultrastructural changes was observed with a CM100 Philips electron microscope.Results The NF-κB in control group had no expression.NF-κB in LPS group mainly expressed in the renal tubular epithelial cell,increased at 1 h after test and peaked at 8 h,and slightly descended at 12 h.The expression of TGF-β1 in control group was slight,and had not show significant difference from control group at 1 h,4 h and 8 h,but significantly higher than that in control group at 12 h.In LPS group,newborn rat renal glomerular basement membrane was complete,part epithelial cell foot processes were fused and renal tubules epithelial cell mild mitochondria vacuolization was found at 4 h.Renal glomeruli epithelial cell foot processes obvious confluenced,quantities of mesangial cells mitochondria vacuole,and renal tubules epithelial cell mitochondria expanded to bubbles at 12 h.Conclusion The NF-κB involves in the pathogenesis of kidney damage induced by endotoxemia,but TGF-β1 may help to repair the damaged kidney,and may repress the production of NF-κB.