Spinal Cord Contusion

Spinal cord injury is a major cause of disability with devastating neurological outcomes and lim-ited therapeutic opportunities, even though there are thousands of publications on spinal cord injury annually. There are two major types of spinal cord injury, transaction of the spinal cord and spinal cord contusion. Both can theoretically be treated, but there is no well documented treatment in human being. As for spinal cord contusion, we have developed an operation with fabulous result.     

In the presence of danger：the extracellular matrix defensive response to central nervous system injury

Glial cells in the central nervous system （CNS） contribute to formation of the extracellular matrix, which provides adhesive sites, signaling molecules, and a diffusion barrier to enhance efficient on and axon potential propagation. In the normal adult CNS, the extracellular matrix （ECM） is relatively stable except in selected regions characterized by dynamic remodeling. However, after trauma such as a spinal cord injury or cortical contusion, the lesion epicenter becomes a focus of acute neuroinflammation. The activation of the surrounding glial cells leads to a dramatic change in the composition of the ECM at the edges of the lesion, creating a perilesion environment dominated by growth inhibitory molecules and restoration of the peripheral/ central nervous system border. An advantage of this response is to limit the invasion of damaging cells and diffusion of toxic molecules into the spared tissue regions, but this occurs at the cost of inhibiting migration of endogenous repair cells and preventing axonal regrowth. The following review was prepared by reading and discussing over 200 research articles in the field published in PubMed and selecting those with significant impact and/or controversial points. This article highlights structural and functional features of the normal adult CNS ECM and then focuses on the reactions of glial cells and changes in the perilesion border that occur following spinal cord or contusive brain injury. Current research strategies directed at modifying the inhibitory perilesion microenvironment without eliminating the protective functions of glial cell activation are discussed.     

对冲性额叶脑挫裂伤合并枕骨骨折的临床特点及治疗（附198例报告）

目的探讨对冲性额叶脑挫裂伤合并枕骨骨折的临床特点和治疗方法。方法回顾性分析198例对冲性额叶脑挫裂伤合并枕骨骨折患者的临床资料,其中急诊手术治疗28例,保守治疗170例（因病情变化,在保守治疗过程中改行手术治疗34例）。结果出院后随访6月～12年,按GOS评分评定预后,恢复良好156例,中残13例,重残17例,死亡12例。结论对冲性额叶脑挫裂伤合并枕骨骨折的患者入院后如果病情危重,危及生命,应急诊手术治疗;如意识障碍较轻,可保守治疗,尽可能延期手术,减少迟发性硬膜外血肿的发生。     

Real-time PCR检测脊髓钝挫伤大鼠TPM4基因的变化

目的观测TPM4在大鼠脊髓钝挫伤后的基因变化,探讨其在脊髓损伤修复中的作用。方法 SD成年大鼠20只,分为假手术组,脊髓钝挫伤12h组,脊髓钝挫伤3d组,脊髓钝挫伤7d组。取损伤段脊髓,通过Q-PCR检测TPM4的基因含量。结果 Q-PCR结果显示大鼠脊髓钝挫伤后12h,脊髓中的TPM4基因表达开始降低,于损伤后3d达最低,损伤后7d逐渐开始增加,均有统计学意义(P0.05)。结论大鼠脊髓损伤后,脊髓中TPM4基因含量变化先降低再升高,提示TPM4可能参与脊髓钝挫伤后的修复。     

Pulmonary contusion mimicking COVID-19: A case report

BACKGROUND Coronavirus disease 2019(COVID-19)is a major public health emergency with obvious characteristics of human-to-human transmission,and there are infective asymptomatic carriers.Early identification and proper management of patients with COVID-19 are important.Features in chest computed tomography(CT)can facilitate identifying newly infected individuals.However,CT findings of some lung contusions are similar to those of COVID-19,as shown in the present case.CASE SUMMARY A 46-year-old woman was admitted to hospital for backache and foot pain caused by a fall injury 1 d before hospitalization.She was suspected of having COVID-19,since there was a confirmed COVID-19 case near her residence.But she had no fever,cough,chest tightness,difficult breathing,nausea,vomiting,or diarrhea,etc.On physical examination,the lower posterior chest of both sides showed dullness on percussion and moist rales at the end of inspiration on auscultation.The white blood cell count and lymphocyte count were 10.88×109/L and 1.04×109/L,respectively.CT performed on February 7,2020 revealed that both lungs were scattered with patchy ground-glass opacity.The patient was diagnosed with pulmonary contusion with thoracic spinal fracture(T12),calcaneal fracture,and pelvic fracture.On day 9 after conservative treatment,her condition was alleviated.On review of the chest CT,the previous shadows were significantly reduced.CONCLUSION Differential diagnosis of lung contusion and COVID-19 must be emphasized.Both conditions require effective prompt actions,especially COVID-19.     

眼挫伤继发青光眼的危险因素及治疗对策

目的探讨眼挫伤继发青光眼的危险因素及其治疗对策。方法选取2006年12月至2011年11月就诊的眼挫伤继发青光眼患者20例,分析其发病原因、治疗方法及治疗效果。结果在20例眼挫伤继发青光眼患者中,前房积血14例（70.00%）;房角挫伤4例（20.00%）;晶状体移位2例（10.00%）。经手术和药物治疗后,眼压控制正常者18例（90.00%）。结论前房积血、房角挫伤、晶状体移位是眼挫伤继发青光眼的危险因素;不同原因所致的眼挫伤继发青光眼所选择的治疗方法也不同,而手术时机是影响治疗效果的重要因素。     

额叶挫裂伤手术时机的选择与对整体认知功能水平的影响分析

目的探讨额叶挫裂伤手术时机的选择与对整体认知功能水平的影响。方法60例额叶挫裂伤患者根据手术治疗时机的不同分为治疗组（30例）与对照组（30例），所有患者首先采用非手术治疗，治疗组同时在入院12—36h内积极采用手术治疗，对照组在入院后36h行手术治疗。结果根据GCS评分，治疗组预后良好率为83．3％，对照组预后良好率为50．0％，差异有统计学意义（P〈0．05）。治疗组患者术后MMSE、LOTCA评分总分与各分项认知测试分数均显著高于对照组（P〈0．05）。治疗组术后的AChE浓度明显低于对照组（P〈0．05），而BDNF浓度显著高于对照组（P〈0．05）。结论早期手术治疗额叶挫裂伤可提高预后良好率，改善整体认知功能水平，其作用的发挥可能与抑制AChE的表达和促进BDNF的释放有关。     

颅底骨折脑挫伤合并颌面部挫裂伤的急诊救治体会

目的探讨颅底骨折脑挫伤并颌面部挫裂伤系统性急诊救治方法的临床效果。方法随机选取2008年间采用常规救治方法对颅底骨折脑挫伤并颌面部挫裂伤患者进行救治的50例病例作为对照组,选取2009年间采用系统的急诊救治方法进行救治的患者50例作为实验组,对比两组的急救治疗效果。结果对照组50例患者中死亡19例、死亡率为38.0%,其中窒息死亡6例、脑疝死亡13例;实验组50例患者死亡8例、死亡率为16.0%,其中窒息死亡1例、脑疝死亡7例;实验组死亡率明显低于对照组,差异具有统计学意义（P〈0.05）。结论对颅底骨折脑挫伤并颌面部挫裂伤首先建立有效的呼吸通道是急诊救治中最重要的环节,可有效提高患者的生存率。