Gunshot-caused Facial Injury Combined with Lower Cervical Spine Injury: A Case Report

A 32-year old male patient was wounded by a pistol. As shown in computed tomography (CT) scanning images, there was comminuted fracture of the left mandible and the bullet was found in the left side behind the sixth cervical vertebra. After the patient was hospitalized, the debridement was done in the emergency room and the operation of open reduction and internal fixation for comminuted fracture of left mandible was performed successfully. Eighteen days later, the patient was taken to surgery for anterior cervical decompression and fusion with autogenous iliac bone grafting for the sixth cervical vertebra. Postoperative follow-up of the patient over two years indicated that the left biceps muscle strength was recovered to level 4. Gunshot wound to the face associated with injury of the low cervical spine has the possibility of survival. It is safe to treat facial wounds early in the patient''s treatment course, even if the bullet remains in the cervical vertebral body and there is neurological function damage.     

Neutrophil recruitment in response to intradermal endotoxin challenge in man

BackgroundNeutrophil recruitment is a key component of the innate immune response, but it is difficult to study in vivo in man, where multi-time-point samples from disease or challenge models are hard to obtain. In-vitro data from our group suggest that neutrophilic inflammation in response to endotoxin will be initiated by a cytokine cascade in which interleukin (IL) 1 has an early and important role. To study this in human beings, we have established a model of intradermal challenge.MethodsEndotoxin and control solution (0·9% NaCl) were injected intradermally in the volar surface of the forearm of healthy volunteers. Serum was taken for blood count and C-reactive protein (CRP) measurements at 0, 1, 6, and 24 h. Temperature, blood pressure, and pulse were monitored. Sites were sampled by 4 mm punch biopsies at varying time points and after varying doses. Biopsy samples were analysed by immunohistochemistry and qPCR.FindingsIntradermal erythema and mild oedema were seen over a current dose range of 0·01–15 ng endotoxin per site. Total dose per individual was 1 to 45 ng. No volunteer had significant systemic reactions. After 5 h, a peripheral blood neutrophilia was seen in some individuals. Erythema area increased up to 6 h, and there was a trend to larger area with larger dose. Above 1 ng endotoxin per site, neutrophilic infiltration of the skin was visible microscopically, but this was much greater at doses of 5 ng or greater. A significant difference was seen between neutrophil elastase stained biopsy area at 2 h and 6 h post administration of endotoxin for the higher doses. There were no changes in serum cytokine levels post injection. By contrast, qPCR revealed a rapid local generation of IL-8 mRNA, and more sustained expression of IL1α/β.InterpretationIntradermal administration of endotoxin within the limits described seems to be safe. It is an effective method of inducing significant local neutrophilic inflammation at an accessible site. Neutrophil infiltration of tissues starts before 2 h and continues beyond 6 h in response to a single dose of endotoxin. Neutrophilia (without CRP rise or symptoms), appears to be associated with a higher total endotoxin dose. IL-8 production at the inflamed site peaks early, whereas IL1α/β mRNA levels remain high at 6 h.FundingNational Institute for Health Research.     

End-of-life decisions without medical assistance in Germany

In contrast to the situation in the Netherlands and Belgium, as well as in the US State of Oregon, but comparable to most European countries, no euthanasia law exists in Germany. Active euthanasia is punishable by Criminal Law and is also prohibited by Professional Law. Two cases of a 59-year-old woman with locked-in syndrome and a 7-year-old boy in a stable vegetative state with convulsions after near-drowning, demonstrate that unbearable suffering may lead relatives (the husband and the grandmother as custodian, respectively) to killing. Both custodians were punished for killing on request and manslaughter, respectively. In neither case had medical doctors been involved. Palliative (terminal) sedation followed by death of the patient as an acceptable side-effect may have been a justifiable medical decision to end the life of the patients.     

The familial risk of acne vulgaris in Chinese Hans – a case-control study

BACKGROUND: Acne is a chronic inflammatory disease of the pilosebaceous follicles. Recent studies bring us increasing evidences that hereditary factors play an important but indirect role in acne. OBJECTIVE: To investigate the possible role of genetic factors in the pathogenesis of acne vulgaris in Chinese Han ethnic group. PATIENTS AND METHODS: Volunteers of 975 acne cases and 580 controls were included, contributing 3009 and 1825 first-degree relatives, respectively. One thousand and eighty-five first-degree relatives of acne cases were affected with facial acne. This compared with 223 first-degree relatives of non-acne controls. The odds ratio was used to estimate the relative risk for acne vulgaris associated with having an affected first-degree relative. RESULTS: The risk of acne vulgaris occurring in a relative of a patient with acne vulgaris was significantly greater than for the relative of an unaffected individual (odds ratio 4.05, 95% confidence interval (CI): 3.45-4.76, P<0.001). CONCLUSION: Our study suggests that familial factors are important in determining individual susceptibility to acne vulgaris.     

经尿道绿激光汽化联合电切割治疗前列腺增生的应用与创伤评价

目的:应用定量指标白细胞介素6和C-反应蛋白评估经尿道绿激光联合电切割手术对机体的创伤程度,进而评价其治疗老年前列腺增生的可行性。方法:选择2005-06/2006-04在解放军第四军医大学西京医院住院的良性前列腺增生患者98例(年龄>60岁),分别行开放性手术(28例)、经尿道绿激光汽化合并电切割术(PVP TURP组,33例)和经尿道绿激光汽化术(PVP组,37例)。绿激光汽化采用美国Laserscope公司生产的非接触式绿激光治疗系统,额定输出汽化功率为80W,电凝功率为30W。用酶联免症吸附法测定3组患者手术前2h,术后24,48h血清中白细胞介素6和C-反应蛋白水平。结果:98例患者全部进入结果分析。①血清白细胞介素6水平:术前2h3组比较差异不显著(P>0.05),术后24和48h均明显高于术前(P<0.05);术后24,48h开放性手术组高于PVP组和PVP TURP组[24h:(5.97±1.35),(1.81±1.64),(2.44±1.45)μg/L,P<0.05;48h:(1.63±0.86),(0.77±0.51),(0.80±1.46),P<0.05]。②血清C-反应蛋白水平:术前2h3组比较差异不显著(P>0.05),术后24和48h均明显高于术前(P<0.05);术后24,48h开放性手术组高于PVP组和PVP TURP组[24h:(62.38±13.65),(10.03±4.05),(28.57±9.8)mg/L,P<0.05;48h:(118.85±20.82),(38.86±8.35),(69.44±13.66),P<0.05];PVP TURP组高于PVP组(P<0.05)。结论:在这3种术式中,开放性手术对机体的创伤最大,机体急性时相反应最显著,经尿道绿激光汽化术合并电切割术对机体创伤较轻,可用于治疗老年前列腺增生症。     

2，4，6-三硝基苯磺酸诱导小鼠炎症性肠病模型的建立

目的:建立2,4,6-三硝基苯磺酸诱导的结肠炎动物模型,并分析其剂量效应。方法:实验于2006-05/09在南方医院消化内科研究所完成,选用SPF级雌性Balb/c小鼠50只,按随机数字表法分为5组,每组10只,对照组予以300g/L乙醇溶液灌肠1次;其他4组分别给予含25mg/kg,50mg/kg,100mg/kg,150mg/kg2,4,6-三硝基苯磺酸的300g/L乙醇溶液灌肠1次。各组于造模后3,7,21,28d各处死1只小鼠,观察结肠的大体形态。造模后21d观察各组小鼠结肠的病理组织切片,并检测中性粒细胞的髓过氧化物酶活性。结果:造模过程中50,100,150mg/kg2,4,6-三硝基苯磺酸组各死亡2,3,3只小鼠。①各组小鼠造模后的一般情况:对照组及25mg/kg2,4,6-三硝基苯磺酸组小鼠发生一过性的结肠机械损伤表现,出现便血等现象,但3～7d后开始缓解;而50～150mg/kg2,4,6-三硝基苯磺酸组小鼠出现便血,腹泻。②各组小鼠结肠的大体形态及病理组织学观察结果:对照组和25mg/kg2,4,6-三硝基苯磺酸组小鼠肠道在第7天时表现为无粘连,局部充血,肠壁不增厚,未见溃疡,于第3周时局部充血已好转;结肠病理切片大致正常。50～150mg/kg2,4,6-三硝基苯磺酸组小鼠肠道肉眼可见粘连,肠腔增大,充血水肿,溃疡形成,出现肠道增厚,病理切片见黏膜下层水肿,固有层炎症细胞浸润等现象,以上现象于造模4周后开始缓解。其中当2,4,6-三硝基苯磺酸剂量为100mg/kg时作用达到高峰。③各组小鼠的中性粒细胞髓过氧化物酶活性比较:50,100,150mg/kg2,4,6-三硝基苯磺酸组均显著高于对照组[(14.17±3.33,18.50±2.33,18.17±1.50,4.83±2.00)nkat/L,(P<0.01)]。结论:应用含100mg/kg2,4,6-三硝基苯磺酸的300g/L乙醇溶液灌肠是诱导小鼠结肠炎较为理想的方法。