Effect of AVP on brain edema following traumatic brain injury

Objective: To evaluate plasma arginine vasopressin (AVP) level in patients with traumatic brain injury and investigate the role of AVP in the process of brain edema. Methods: A total of 30 patients with traumatic brain injury were involved in our study. They were divided into two groups by Glasgow Coma Scale: severe traumatic brain injury group (STBI, GCS≤8) and moderate traumatic brain injury group ( MTBI, GCS >8). Samples of venous blood were collected in the morning at rest from 15 healthy volunteers (control group) and within 24 h after traumatic brain injury from these patients for AVP determinations by radioimmunoassay. The severity and duration of the brain edema were estimated by head CT scan. Results: plasma AVP levels (ng/L) were (mean±SD): control, 3. 06±1. 49; MTBI, 38. 12±7. 25; and STBI, 66. 61±17. 10. The plasma level of AVP was significantly increased within 24 h after traumatic brain injury and followed by the reduction of GCS, suggesting the deterioration of cerebral injury (P<0. 01). And the AVP level was correlated with the severity (STBI r =0.919, P < 0.01; MTBI r = 0.724, P < 0.01) and the duration of brain edema (STBI r = 0. 790, P < 0. 01; MTBI r = 0. 712, P<0.01). Conclusions: The plasma AVP level is closely associated with the severity of traumatic brain injury. AVP may play an important role in pathogenesis of brain edema after traumatic brain injury.     

红花注射液对脊髓损伤早期自由基影响的实验研究

目的:通过观察对大鼠脊髓损伤模型早期使用红花注射液后自由基的变化探讨红花注射液防止脊髓继发性损伤的作用机制。方法:选择成年雄性SD大鼠48只,分为正常对照组、损伤组、红花治疗组,每组大鼠16只。采用Allen’s撞击法建立脊髓损伤模型,其中红花治疗组分别于打击后30 min、2、4 h腹腔注射红花注射液。术后6 h测定脊髓组织和血液中丙二醛(MDA)和超氧化物歧化酶(SOD)的含量,并在光镜下观察组织形态的变化。结果:损伤组血液标本和脊髓标本中MDA升高、SOD降低,红花组血液和脊髓标本所测定的各个指标与损伤组比较有显著性差别(P<0.01),红花组与对照组各指标无明显差别(P>0.05)。组织学形态上,红花治疗组脊髓损伤程度小,神经元细胞破坏少。结论:脊髓损伤后血液和脊髓组织中自由基含量升高,红花注射液能有效清除自由基,在一定程度上能防止脊髓继发性损伤。注射红花注射液后,MDA降低,SOD升高。     

胆碱酯酶抑制剂他克林对兔内毒素性脑损伤的影响

目的 评价胆碱酯酶抑制剂他克林对兔内毒素性脑损伤的影响.方法 健康成年雄性新西兰大白兔21只,体重1.7～2.3 ks,采用随机数字表法,将其随机分为3组(n＝7):假手术组(S组)脑池内注射生理盐水；内毒素组(LPS组)脑池内注射内毒素200 μg/kg;胆碱酯酶抑制剂组(THA组)脑池内注射内毒素200 μg/kg和盐酸他克林150 μg/kg.注射后4h时处死动物,取脑组织,提取细胞核蛋白,采用Western blot法测定NF-κBp65表达,ELISA法测定血浆、脑脊液和脑组织TNF-α水平,采用分光光度法测定脑组织髓过氧化物酶(MPO)活性,称重后计算湿干重比.结果 与S组比较,LPS组和THA组NF-κB p65表达上调,血浆、脑脊液和脑组织TNF-α水平、MPO活性和湿干重比升高(P<0.05)；与LPS组比较,THA组NF-κB p65表达下调,血浆、脑脊液和脑组织TNF-α水平、MPO活性和湿干重比降低(P<0.05).结论 胆碱酯酶抑制剂他克林可通过抑制局部炎性反应减轻兔内毒素性脑损伤.     

Effect of Xingnaojing injection on cerebral edema and blood-brain barrier in rats following traumatic brain injury

Objective：To explore the effects of Xingnaojing injection on cerebral edema and blood-brain barrier （BBB） in rats following traumatic brain injury （TBI）.Methods： A total of 108 adult male Sprague-Dawley rats were used as subjects and randomly assigned to three groups：sham-operation,TBI and Xingnaojing injection was set up by the improved device of Feeney＇s weightcontent and BBB permeability expressed as Evans blue content were measured at 1, 3, 5 and 7 days after surgery.Results： In sham-operation group, brain water content and Evans blue content in brain tissue were 78.97%±1.22%and 5.13μg±0.71μg. Following TBI, water content in brain tissue was increased significantly at 1, 3, 5 and 7 days （83.49%±0.54%, 82.74%±0.72%, 80.22%±0.68%, 79.21%±0.60%）, being significantly higher than that in sham operation group （P〈0.05）. Evans blue content was increased in TBI group （16.54 μg±0.60 μg, 14.92μg±0.71μg, 12.44 μg ±0.92μg, 10.14μg±0.52 μg） as compared with sham-operation group（P〈0.05）. After treatment with Xingnaojing injection, brain water content decreased as compared with TBI group （81.91%±1.04%, 80.38%±0.72%, 79.54%±0.58%,78.60%±0.77%, P〈0.05）. Xingnaojing injection also reduced the leakage of BBB as compared with TBI group （15.11 μg± 0.63 μg, 13.62 μg±0.85μg, 10.06 μg±0.67 μg, 9.54 μg±0.41 μg,P〈0.05）.Conclusion： Xingnaojing injection could alleviate cerebral edema following TBI via reducing permeability ofBBB.     

Therapeutic effect of mild hypothermia on severe traumatic head injury

ldhypothermia (33 35℃ )isbeneficialforbrainprotectionandthusreducesthemortalityofthepatientswithseveretraumaticbraininjury (TBI) ,whichhasbeen provedbyclinicalandexperimentalevidences .1,2 However ,hypothermialeadstosuchcomplicationsasseveresecondaryinfectionsandshockduringrewarming .1InordertofurtherevaluatetheeffectofhypothermiaonsevereTBI ,wetreatedsuch patientswithmildhypothermiaandnormothermia ,respectively ,ananalyzedtheirclinicaleffectsprospectively .METHODSClinicaldataBetween 199…     

脊髓损伤后脊髓自由基和超氧化物岐化酶的动态变化

目的：研究脊髓损伤后脊髓内自由基丙二醛(MDA)含量及超氧化物岐化酶(SOD)的活性变化，以探讨自由基在脊髓继发性损伤中的作用机制。方法：42只健康家兔采用改良式Allen氏法造成脊髓损伤模型，测定其损伤后12h、48h、3d、7d、14d及21d脊髓组织内自由基含量和超氧化物岐化酶的活性。结果：脊髓损伤后，MDA在24h内显著升高，7d达最高峰，升幅达90％，并随之逐渐下降；伤后SOD活性显著下降，3d时达最低，降幅达54％，随后并逐渐回升。结论：自由基和超氧化物歧化酶参与了脊髓继发性损伤的病理过程。     

Retinochoroidal changes after severe brain impact injury in rabbits

ＣＲｅｓｅａｒｃｈＩｎｓｔｉｔｕｔｅｏｆＳｕｒｇｅｒｙ/ＤａｐｉｎｇＨｏｓｐｉｔａｌ,ＴｈｉｒｄＭｉｌｉｔａｒｙＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ ,Ｃｈｏｎｇｑｉｎｇ 40 0 0 42 ,Ｃｈｉｎａ (ＹｅＪ ,ＹｕａｎＲＤ ,ＬｉｕＳＺ ,ＷａｎｇＺＧａｎｄＺｈｕＰＦ)ｌｏｓｅｄｅｙｅｄａｍａｇｅｓｕｓｕａｌｌｙｏｃｃｕｒａｆｔｅｒｂｌｕｎｔｂｒａｉｎｉｎｊｕｒｙ .Ｔｈｅｉｎｃｉｄｅｎｃｅｒａｔｅｉｓ 0 .5% 5%ｉｎｃｌｏｓｅｄｂｒａｉｎｉｎｊｕｒｙ .1Ａｂｏｕｔ 50 %ｏｆｔｈｅｐａｔｉｅｎｔｓｒｅｍａｉｎｐｅｒｍａ…     

Effect of endothelin and endothelin A receptors on regional cerebral blood flow after traumatic brain injury in rabbits

Objective:To investigate the effect of endothelin and endothelin A receptors (ETAR) on regional cerebral blood flow after traumatic brain injury (TBI).Methods:The changes of endothelin-1(ET-1)content with radioimmunoassay,mRNA expression and the location of ETAR with in situ hybridization,and the function and effect of antagonist BQ123 on regional cerebral blood flow(rCBF) through intracisternal application were dynamically observed on 130 adult rabbits after TBI.Results:ET-1 increased significantly in regional brain tissues,and the expression of ETAR mRNA increased apparently and predominantly distributed in the cerebromicrovascular endothelium after trauma.The rCBF declined significantly,but by using selective ETAR antagonist BQ123 to treat the rabbits,the decrease of rCBF could be apparently prevented.Conclusions:It demonstrates that ET-1 may primarily contribute to the rCBF decrease after TBI,while providing that the role of ET-1 is mediated throught ETAR.     

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目的 了解全身炎症反应综合征（ＳＩＲＳ）病人血浆自由基反应的变化情况。以及自由基反应与ＳＩＲＳ程度的关系。方法 检测了５８例腹膜炎引发的ＳＩＲＳ病人的血浆过氧化脂质（Ｐ－ＬＰＯ）、血浆维生素Ｃ（Ｐ－ＶＣ）、血浆维生素Ｅ（Ｐ－ＶＥ）、血浆β－胡萝卡素（Ｐ－β－ＣＡＲ）,与６０例健康成年人的上述检测值作比较。并分析了以上各检测值与病人ＡＰＡＣＨＥⅡ积分的关系。结果 与对照组比较,ＳＩＲＳ组Ｐ－ＬＰＯ平均含量显著升高,并与ＡＰＡＣＨＥⅡ积分呈直线正相关;Ｐ－ＶＣ、Ｐ－ＶＥ、Ｐ－β－ＣＡＲ显著下降,与ＡＰＡＣＨＥⅡ积分呈直线负相关。结论 腹膜炎引发的ＳＩＲＳ病人体内存在自由基反应病理性增加、氧化抗氧化失衡,测定Ｐ－ＬＰＯ、Ｐ－ＶＣ、Ｐ－ＶＥ、Ｐ－β－ＣＡＲ在一定程度上可作为判断和动态监察ＳＩＲＳ病情的指标。     

氯胺酮对脑冷冻伤后自由基和脑水肿的影响

目的 探讨N-甲基-D-天门冬氨酸(N—methyl—D-aspartate，NMDA)受体非竞争性拮抗药氯胺酮对鼠脑冷冻伤后脑内超氧化物歧化酶(superoxide dismutase，SOD)、丙二醛(malondialdehyde，MDA)和脑水肿的影响。方法 49只SD大鼠随机分为假手术组、未治疗组和氯胺酮治疗组。采用液氮局部冷冻左侧鼠脑30s制作冷冻伤模型，分别于2、6、24h处死动物后，用分光光度法测10％脑组织匀浆中SOD活性和MDA产量。结果 脑组织含水量在冷冻伤后显著升高，并随时间延长而加重。氯胺酮治疗后脑组织含水量没有明显减少；脑组织SOD活性在2、6h高于未治疗组，但24h后SOD活性无显著差异。MDA含量比未治疗组在相应时段显著减少。结论 自由基是脑水肿形成的重要因素，氯胺酮能减轻冻伤脑组织中SOD活性的抑制，减少MDA生成，但对脑水肿无明显治疗作用。     

Effect of dexamethasone by local treatment on cerebral edema and serum myelin basic protein after brain injury in rabbits

ＳＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ ,ＴｈｅＦｉｒｓｔＡｆｆｉｌｉａｔｅｄＨｏｓｐｉｔａｌ,ＨｅｎａｎＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ ,Ｚｈｅｎｇｚｈｏｕ 45 0 0 5 2 ,Ｃｈｉｎａ (ＹａｎｇＢａｎｄＳｏｎｇＬＪ)ＡｌｂｅｒｔＥｉｎｓｔｅｉｎＣｏｌｌｅｇｅｏｆＭｅｄｉｃｉｎｅｏｆＹｅｓｈｉｖｅＵｎｉｖｅｒｓｉｔｙ ,ＮｅｗＹｏｒｋ ,10 46 1(ＧｕａｎＦＸ)ＴｈｅＰｈｙｓｉｃｓＤｅｐａｒｔｍｅｎｔｏｆＨｅｎａｎＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ ,Ｚｈｅｎｇｚｈｏｕ 45 0 0 5 2 ,Ｃｈｉｎａ (Ｌｉ…     

Spironolactone in preventing hypokalemia following traumatic brain injury

Objective： Hypokalemia is a frequent complication observed after traumatic brain injury （TBI）.We evaluated the effect of spironolactone on preventing hypokalemia following moderate to severe TBI.Methods： Patients with moderate to severe TBI, whose Glasgow Coma Scale （GCS） scores of 9-12 and ＜9,respectively, were equally randomized into intervention and control groups, matching with severity of trauma and baseline serum level of potassium. For the intervention group, we administrated spironolactone （1 mg/kg per day）on the second day of admission or the first day of gavage tolerance and continued it for seven days. No additional intervention was done for controls. Hypokalemia （mild： 3-3.5 mg/L, moderate： 2.5-3 mg/L, and severe： ＜2.5 mg/L serum K＋） and other electrolyte abnormalities were compared between the two groups at the end of the intervention.Results： Sixty-eight patients （58 males and 10 females）were included with mean age=（33.1±11.8） years, and GCS=7.6±2.8. The two groups were similar in baseline characteristics.Patients who received spironolactone were significantly less likely to experience mild, moderate, or severe hypokalemia （8.8%, 2.9%, and 0） compared with controls （29.4%, 11.7%,and 2.9%, respectively, P＜0.05）. No significant difference was observed between the two groups in the occurrence of other electrolyte abnormalities, hyperglycemia or oliguria.Conclusion： Spironolactone within the first week of head injury could prevent the occurrence of late hypokalemia with no severe side effects.     

缺氧预处理对缺血缺氧脑组织超微结构与自由基的影响

目的 观察缺氧预处理对缺血缺氧脑组织超微结构及脑组织自由基的影响。方法 将40只小鼠随机分为4组。A组为盐水对照组,B组为缺氧预处理组,IH组为缺血缺氧组,BIH组为缺氧预处理后缺血缺氧组。各组有6只小鼠分别采用黄嘌呤氧化酶法和硫代巴比妥酸法和硫巴比妥酸法检测脑组织的超氧化物歧化酶（SOD）活性和丙二醛（MDA）含量,另4只小鼠用于透射电镜下脑组织超微结构的观察。结果 与A组比较,B组SOD活性增加,IH组MDA组含量明显增加,而IH组SOD活性明显增加的同时,MDA含量比IH明显降低。电镜显示B组除部分神经元轻度肿胀外,脑组织超微结构基本同A组,IH组细胞核变形,细胞浆成空泡,严重者满视野几乎找不到正常细胞,无损害的神经元＜10％,BIH组细胞结构基本恢复正常,无损伤神经元达63％。结论 缺氧预处理对再缺血缺氧引起的神经元损伤有保护作用,内源性抗氧化物质的增加与其有直接关系。     

Oxygen derived free radicals in plastic surgery — Therapeutic interest of fighting free radicals: the superoxide dismutases

Summary Free radicals are incriminated as being responsible for cellular lesions during irradiation, inflammatory phenomena, and the syndrome of ischemia followed by reperfusion. These 3 processes are of interest to plastic surgeons. It would be useful to protect the tissue from the free radicals during irradiation for breast cancer with a view to secondary reconstruction in tissue of unproved quality. Limiting the inflammatory phenomena in burned patients would also be helpful. The ischemic reperfusion syndrome occurs in flap surgery, in microsurgery and during all surgical procedures which involve clamping pedicles. Finally shock, which causes an ischemic reperfusion syndrome over the entire organism, also favors the formation of free radicals and it is interesting to consider the possibility of combating the free radicals in the shock accompanying extensive burns. Among the enzymes destined to fight these radicals, superoxide dismutase was the first to be discovered and is the best known, since it has been the subject of numerous animal experiments and many applications in humans. Currently it seems more efficient than other substances in combating ischemic type lesions.     

Effect of intracranial pressure and cerebral perfusion pressure on outcome prediction of severe traumatic brain injury

ｒａｕｍａｔｉｃｂｒａｉｎｉｎｊｕｒｙｉｓｏｎｅｏｆｔｈｅｌｅａｄｉｎｇｃａｕｓｅｓｏｆｄｅａｔｈｉｎｔｈｅｉｎｄｕｓｔｒｉａｌｉｚｅｄｗｏｒｌｄａｎｄｃｏｓｔｓｍｏｒｅｔｈａｎｔｅｎｂｉｌｌｉｏｎＵＳｄｏｌｌａｒｓｉｎｔｈｅＰｅｏｐｌｅ ｓＲｅｐｕｂｌｉｃｏｆＣｈｉｎａｅａｃｈｙｅａｒ .Ｆｕｒｔｈｅｒｍｏｒｅ ,ｔｈｏｕｓａｎｄｓｏｆｓｕｒｖｉｖａｌｓａｒｅｌｉｖｉｎｇｗｉｔｈｌｏｎｇ ｔｅｒｍｄｉｓａｂｉｌｉｔｉｅｓｆｒｏｍｔｒａｕｍａｔｉｃｂｒａｉｎｉｎｊｕｒｙ .Ｔｈｅｉｍｐａｃｔｏｆｓｅｃｏ…     

Influence of apolipoprotein E and its receptors on cerebral amyloid precursor protein metabolism following traumatic brain injury

Traumatic brain injury (TBI) is the leading cause of mortality and disability among young individuals in our society,and globally the incidence of TBI is rising sharply.Mounting evidence has indicated ...     

Outcome of 2 284 cases with acute traumatic brain injury

ＴＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ ,ＲｏｎｇｇａｎｇＨｏｓｐｉｔａｌ ,Ｓｈｅｎｚｈｅｎ5 18116 ,Ｃｈｉｎａ (ＺｈａｎｇＪａｎｄＺｈｏｎｇＴＡ)ＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ ,ＣｈａｎｇｚｈｅｎｇＨｏｓｐｉｔａｌ,ＳｈａｎｇｈａｉＮｅｕｒｏｓｕｒｇｅｒｙＩｎｓｔｉｔｕｔｅ ,Ｓｈａｎｇｈａｉ 2 0 0 0 0 3 ,Ｃｈｉｎａ(ＪｉａｎｇＪＹ ,ＹｕＭＫａｎｄＺｈｕＣ)ｒａｕｍａｔｉｃｂｒａｉｎｉｎｊｕｒｙ (ＴＢＩ) ,ａｃｏｍｍｏｎｃｌｉｎｉｃａｌｐｒｏｂｌｅｍｆｏｒｎｅｕｒｏｓｕｒｇ…     

Effect of superoxide dismutase on haematologic parameters and urinary changes after burn injury in rats

Summary This study was designed to examine the possible benefits that superoxide dismutase (SOD), a free radical scavenger, could induce upon some of the hematologic and urinary alterations occurring during the burn shock syndrome. The experiment was conducted by comparing two groups of rats treated with SOD and saline solution respectively, immediately after inducing a scald burn injury. Statistically significant differences were observed between the two groups in the mean increases of hematocrit and total hematic hemoglobin concentration 15 min postburn (p < 0.05) and in the presence or absence of urinary pigments (p < 0.001) 60 min postburn. These results demonstrate the role of oxygen free radicals in the physiopathology of the first stages of burn shock syndrome.     

Effect of superoxide dismutase on acute reperfusion injury of the rabbit brain

Summary To study the involvement of free oxygen radicals of the blood-brain barrier (BBB) disruption during early reperfusion, we isolated the distal internal carotid artery, and the middle and anterior cerebral arteries via the transorbital approach in anesthetized rabbits. Using radiolabeled microspheres, regional cerebral blood flow (rCBF) was measured before, during and after 1-hour unilateral occlusion of these vessels. Fifty-five minutes after ischemia, animals received intravenous saline placebo (control), superoxide dismutase (SOD) at 8mg/kg=30000 U/kg, or weakened superoxide dismutase (wSOD) at 8mg/kg=30000 U/kg.Integrity of the BBB was assessed by leakage of Evan's Bluealbumin dye (EB-albumin dye), which was given at 15 minutes of reperfusion and allowed to circulate for an additional hour. In the control and wSOD-treated groups, rCBF decreased (26% and 40% of control, respectively) within the blue-tinted tissue of the occluded hemisphere during ischemia; hyperemia was observed during early reperfusion. In the control and wSOD-treated groups, EB-albumin dye leakage across the BBB increased 49% within the occluded hemisphere. However, within the SOD-treated group, the BBB showed minimal dye leakage even though rCBF of the occluded hemisphere (so-called blue-tinted tissue) decreased by 38% during ischemia. We conclude that 1-hour focal cerebral ischemia and reperfusion produce a vascular endothelial injury at the BBB. Since SOD administration showed significant protection, free-oxygen-radical production during early reperfusion is associated with break-down of the BBB to large molecules.